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Adjuvant immunotherapy for melanoma

Jeffrey A Sosman, MD
Section Editor
Michael B Atkins, MD
Deputy Editor
Michael E Ross, MD


Surgical excision is the treatment of choice for early cutaneous melanoma and is curative in most cases. However, some patients will subsequently relapse with disseminated disease. High-risk features in the primary tumor and regional lymph node metastasis define patient subsets that are at increased risk for recurrent disease.

Adjuvant immunotherapy with interferon alfa (IFNa) prolongs disease-free and overall survival in selected patients at increased risk for disease dissemination. High-dose IFNa continued for one year has been the standard of care for patients with resected node-positive melanoma (stage III) and should be considered for patients with negative nodes and an increased risk of recurrence (stage IIB and IIC (table 1A-B)). More recently, the checkpoint inhibitor ipilimumab has been shown to significantly decrease the rate of recurrence, and this may offer an alternative to interferon.

A number of other approaches have been studied to reduce the risk of recurrence in patients thought to be at high risk for relapse. These include adjuvant chemotherapy with agents such as dacarbazine [1-3]; nonspecific immune adjuvants such as Bacillus Calmette-Guerin (BCG) vaccine [1,4,5], Corynebacterium parvum [5-7], or levamisole [8-10]; and hormonal agents such as megestrol acetate. However, none of these agents, used either alone or in various combinations, proved beneficial when compared with either observation or placebo in randomized clinical trials.

The use of adjuvant immunotherapy with IFNa and ipilimumab will be reviewed here, along with a brief discussion of other experimental approaches to adjuvant therapy.


The rationale for the use of adjuvant interferon alfa (IFNa) as therapy following disease resection is based upon early clinical studies that demonstrated antitumor activity in patients with metastatic melanoma. Both animal model and histologic evidence suggest that the effects of IFNa are mediated through effects on host cells rather than through a direct effect on tumor cells [11,12].


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Literature review current through: Sep 2016. | This topic last updated: Sep 8, 2016.
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