Howard L. Kaufman, MD
New therapeutic approaches for treating patients with earlier-stage melanoma who face a higher risk of recurrence are among the features of recently updated consensus guidelines from the Society for Immunotherapy of Cancer (SITC).1
The guidelines take stock of the extensive changes that have occurred in the field in less than a decade, with the goal of helping to stratify patients, choose optimal treatment regimens, and manage adverse events (AEs) in patients with stage II to IV disease.
An example of how the SITC melanoma guidelines have evolved concerns patients with higher-risk stage IIB-C disease. In 2013, a majority of subcommittee members recommended standard 1-year, high-dose interferon alfa-2b for high-risk patients. Now, in 2018, most members (55%) recommend enrollment onto a clinical trial for these patients, with or without selection by a prognostic or predictive biomarker. Those who did not recommend a clinical trial were twice as likely to recommend observation over adjuvant interferon alfa-2b (20% vs 10%).
Managing Stage III Disease
Perhaps the largest update within the new SITC melanoma guidelines concerns how to treat patients with stage III disease. In 2013, the subcommittee considered all stage III patients as a single group. In this update, the subcommittee had to balance recent updates to the American Joint Committee on Cancer (AJCC) staging system for melanoma. In all, 30% of the subcommittee felt that stage III patients should still be treated similarly, but the majority believed that cancer behaves differently in patients with microscopic metastasis to a single lymph node (stage NIa, AJCC seventh), especially when the node has been excised by sentinel lymphadenectomy, compared with patients who have more extensive lymph node involvement (stages NIb-III, AJCC seventh). As such, independent treatment algorithms were generated for each population.
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