Adjuvant therapy for melanoma

Background: Melanoma has become increasingly prevalent in recent years. While surgical resection is the primary treatment for early stage melanoma, adjuvant therapy is often necessary to prevent recurrence in patients at high risk.Objectives: In this article, we review the current state of adjuvant therapy for melanoma and discuss the various treatment options available, including checkpoint inhibitors and BRAF/MEK inhibitors.Materials and methods: We performed a selective literature search in PubMed.Results: For stage IIB/C, III and IV prospective clinical trials have shown that adjuvant immunotherapy or targeted therapy (in patients with V600E/K-mutated melanoma) can reduce the risk of recurrence and distant metastases. Formal evidence for a survival benefit is pending. While treatment-related deaths are very rare, adjuvant therapies can cause significant morbidity. In particular, adjuvant immunotherapy can cause life-long adverse events. During treatment, adjuvant BRAF/MEK inhibition prevents more relapses than PD-1 blockade in stage III patients in indirect comparison.Conclusions: Modern adjuvant therapy in melanoma reduces the risk of recurrence. Extended follow-up is needed to fully assess whether adjuvant therapy also reduces the risk of death in stage II and III melanoma. A careful risk-benefit assessment including appropriate staging and participatory decision making is warranted since adverse events related to adjuvant therapy are frequent.