Wednesday, June 29, 2016
Surgical management and adjuvant therapy for high risk melanoma....many questions...still waiting on answers!!!
Surgical Management and Adjuvant Therapy for High-Risk and Metastatic Melanoma. Akkooi, Atkins, Agarwala, Lorigan. Am Soc Clin Oncol Educ Book. 2016
Wide local excision is considered routine therapy after initial diagnosis of primary melanoma to reduce local recurrences, but it does not impact survival. Sentinel node staging is recommended for melanomas of intermediate thickness, but it has also not demonstrated any indisputable therapeutic effect on survival. The prognostic value of sentinel node staging has been long established and is therefore considered routine, especially in light of the eligibility criteria for adjuvant therapy (trials). Whether completion lymph node dissection after a positive sentinel node biopsy improves survival is the question of current trials. The MSLT-2 study is best powered to show a potential benefit, but it has not yet reported any data. Another study, the German DECOG study, presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting did not show any benefit but is criticized for the underpowered design and insufficient follow-up. There is no consensus on the use of adjuvant interferon in melanoma. This topic has been the focus of many studies with different regimens (low-, intermediate-, or high-dose and/or short- or long-term treatment). Adjuvant interferon has been shown to improve relapse-free survival but failed to improve overall survival. More recently, adjuvant ipilimumab has also demonstrated an improved relapse-free survival. Overall survival data have not yet been reported due to insufficient follow-up. Currently, studies are ongoing to analyze the use of adjuvant anti-PD-1 and molecular targeted therapies (vemurafenib, dabrafenib, and trametinib). In the absence of unambiguously positive approved agents, clinical trial participation remains a priority. This could change in the near future.
Here are the results of my Nivo/Opdivo study for 33 Stage IV, NED ratties: Cest moi! Results in my Nivo/Opdivo trial published!!
That trial started in 2010! Results were published in 2014. I realize folks are waiting to see what will happen to us...but come on, researcher peeps!!!! Let's get to tallying some more numbers and looking at what happens to us with no treatment as a comparator. Plenty of folks need answers sooner rather than later!!! Hang in there, ratties!!! - c