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Annals of Oncology 2009 20(Supplement 6):vi30-vi34; doi:10.1093/annonc/mdp250
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
The online version of this article has been published under an open access model. users are entitle to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and the European Society for Medical Oncology are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

This article appears in the following Annals of Oncology issue: Melanoma: Perspectives of the Global Melanoma Task Force [View the issue table of contents]

Articles

Utility of adjuvant systemic therapy in melanoma

A. M. M. Eggermont1,*, A. Testori2, J. Marsden3, P. Hersey4, I. Quirt5, T. Petrella6, H. Gogas7, R. M. MacKie8 and A. Hauschild9

1 Department of Surgical Oncology, Erasmus University Medical Center–Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
2 European Institute of Oncology, Division of Melanoma, Milan, Italy
3 University Hospital Birmingham, Birmingham, UK
4 Immunology and Oncology Unit, Calvary Mater Newcastle Hospital, New South Wales, Australia
5 Princess Margaret Hospital, Toronto
6 Toronto Sunnybrook Regional Cancer Center, Toronto, Canada
7 First Department of Medicine, Medical School, University of Athens, Greece
8 Department of Public Health and Health Policy, University of Glasgow, UK
9 Department of Dermatology, University of Kiel, Kiel, Germany

* Correspondence to: Alexander M. M. Eggermont, Professor of Surgical Oncology, Erasmus MC–Daniel den Hoed Cancer Center, 301 Groene Hilledijk, 3075 EA Rotterdam, The Netherlands; Tel: +31-10-4391911; Fax: +31-10-4391011; E-mail: a.m.m.eggermont{at}erasmusmc.nl

The lack of effective drugs in stage IV melanoma has impacted the effectiveness of adjuvant therapies in stage II/III disease. To date, chemotherapy, immunostimulants and vaccines have been used with minimal success. Interferon (IFN) has shown an effect on relapse-free survival (RFS) in several clinical trials; however, without a clinically significant effect on overall survival (OS). A recently conducted meta-analysis demonstrated prolongation of disease-free survival (DFS) in 7% and OS benefit in 3% of IFN-treated patients when compared with observation-only patients. There were no clear differences for the dose and duration of treatment observed. Observation is still an appropriate control arm in adjuvant clinical trials. Regional differences exist in Europe in the adjuvant use of IFN. In Northwest Europe, IFN is infrequently prescribed. In Central and Mediterranean Europe, dermatologists commonly prescribe low-dose IFN therapy for AJCC stage II and III disease. High-dose IFN regimens are not commonly used. The population of patients that may benefit from IFN needs to be further characterised, potentially by finding biomarkers that can predict response. Such studies are ongoing.

Key words: adjuvant therapy, interferon, melanoma, metastasis, randomised trials


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