What is the role of medications in the treatment of cutaneous melanoma?

Updated: Oct 13, 2020
  • Author: Susan M Swetter, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

High-dose interferon (IFN) alfa-2b was the first  adjuvant therapy approved by the US Food and Drug Administration (FDA) for high-risk resected melanoma, defined as deep primaries greater than 4 mm in Breslow depth (AJCC stage IIB) and regional lymph node metastasis (stage III). Various trials of low-dose IFN have shown no benefit in disease-free relapse or overall survival (OS) rates, [145] although a benefit in both disease-free and OS was suggested in a study of low-dose IFN in resected stage III patients in a German Dermatologic Cooperative Oncology Group study. [146] A 2012 analysis of adjuvant therapy with low-dose pegylated IFN (PEG-IFN) administered for 36 months versus low-dose IFN for 18 months in melanoma patients with macrometastatic nodes did not reveal differences in disease-free survival, distant metastasis-free survival (DMFS), or OS, suggesting lack of superiority of adjuvant low-dose PEG-IFN. [147] Similarly, multiple melanoma vaccine trials are in progress, predominantly for stage III and IV disease, but they have not demonstrated an OS advantage to date.

Ipilimumab, a CTLA-4 blocker, was FDA approved in 2015 for resected stage III melanoma, although the risk of immune-related adverse events have tempered enthusiasm for the high-dose regimen in the adjuvant setting. [88, 115]

Talimogene laherparepvec (Imlygic) was approved in 2015. It is a genetically modified, live-attenuated herpes simplexvirus programmed to replicate within tumors and produce the immune-stimulatory protein granulocyte macrophage colony-stimulating factor (GM-CSF). It is indicated for the local treatment of unresectable cutaneous, subcutaneous, and nodal lesions in patients with melanoma recurrence after initial surgery.


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