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Adjuvant immunotherapy alone improves DMFS in patients with stage III melanoma

Among patients with stage III melanoma with occult lymph node metastasis who choose to not undergo completion lymph node dissection (CLND), adjuvant immunotherapy is associated with longer distant metastasis-free survival (DMFS).

These findings come from a paper published in Annals of Surgical Oncology (Feb. 2022; 29(2):806-815).

The retrospective study included 90 patients with a positive sentinel lymph node biopsy who did not undergo CLND. Of those, 56 received adjuvant therapy and 34 were only observed.

Investigators noted that the patients who received adjuvant therapy were younger (mean age: 53 vs. 65 years, p<0.001) and had higher overall melanoma stage (Stage IIIb/c 75% vs. 54%, p=0.041).

Twelve patients in the observation group (35%) and recurrence, compared to 11 (20%) in the adjuvant therapy group.

The most common first site of recurrence was distant recurrence alone (five of 34 patients) in the observation group and nodal recurrence alone (eight of 90 patients) in the adjuvant therapy group.

The two-year nodal recurrence rate and recurrence-free survival rate were not significantly different between the adjuvant and observation groups. However, in patients with stage IIIb/c disease, adjuvant therapy was associated with a significantly improved 24-month DMFS (86% vs. 59%, p=0.04).

“As treatments for melanoma have evolved, the standard of care may be evolving as well,” said study author Dr. Martin McCarter in a press release. “This study took a look at the patients who had a sentinel lymph node biopsy, so we knew the patient had a positive melanoma metastasis to their regional node. Those folks historically used to go on and get the completion lymph node dissection, but recently, people started to forego doing that lymph node dissection, which did not improve survival, and instead moved directly to immunotherapy, which did improve survival in other clinical trials. We proved that this is acceptable, that we’re not causing more harm to patients by doing it, and that those who do go on to get the immunotherapy seem to benefit from it.”

Dr. McCarter is a professor of surgical oncology at the Colorado University School of Medicine.


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