Adjuvant Therapy of Melanoma Overview on IFN

Another abstract to be presented on Saturday Nov 12, 2011 by  Sanjiv S. Agarwala MD  Professor of Medicine, Temple University School of Medicine, Chief, Oncology and hematology, St Luke’s Cancer Center, Bethlehem, PA

Adjuvant Therapy of Melanoma Overview

Another abstract to be presented on Saturday Nov 12, 2011 by  Sanjiv S. Agarwala MD  Professor of Medicine, Temple University School of Medicine, Chief, Oncology and hematology, St Luke’s Cancer Center, Bethlehem, PA

Adjuvant Therapy of Melanoma Overview

One of the main issues confronting clinicians who treat patients with high-risk melanoma after surgical resection is the use of adjuvant therapy to prevent reoccurrence and improve survival. After decades of research, the only agent that has consistently shown an impact in improving relapse free survival (RFS) and less consistently on overall survival (OS) is interferon-alpha. The regimen most commonly used in the US is the high dose interferon (IFN) regimen (HDI) of induction therapy given at 20 MU/m2/day for 5/7 days/week for 4 weeks intravenously followed by maintenance of 10 MU/m2/day tiw for 48 weeks subcutaneously.

Two important issues that have recently been researched are (1) the use of induction therapy only or (2) the use of prolonged lower dose therapy with a longer acting pegylated (PEG) IFN.  The former issue was recently clarified with the results of E 1697, a trial that randomized patients with intermediate and high-risk melanoma to induction therapy for 4 weeks only or observation. No significant difference between the treatment and observation arms were noted in 1111 patients randomized indicating that induction therapy alone was inadequate. The latter issue was addressed by EORTC trial 18991 which randomized 1256 patients with node positive melanoma to 5 years of PEG IFN administered weekly ( 6 ug/kg/week for 8 weeks followed by 3 ug/kg/week) or observation. A statistically significant improvement in RFS was noted for the treated patients. Based on these results, the FDA approved PEG-IFN for surgically cured patients with stage III melanoma in 2011.

Clinicians and patients now have a choice of IFN regimens for stage III disease, with HDI still standard for IIB and IIC disease. Ongoing and future trials addressing the potential value of newly approved agents in stage IV melanoma such as ipilimumab and vemurafenib will be an important to move this field forward.