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ESMO E-Learning: Melanoma Adjuvant Setting

Learning objectives

  • To provide an update on the risk stratification in patients with primary melanoma and rational for adjuvant treatment
  • To provide an overview of clinical trials and the use of immunotherapy and targeted therapy in the adjuvant melanoma treatment
  • To put the results from the clinical trials in the adjuvant treatment for melanoma, into clinical context


In patients with a complete resection of melanoma, the decision on adjuvant treatment depends on a risk category. Particularly the extent and characteristics of the primary tumour and the regional lymph node involvement allow the classification of patients into different risk categories. Upon consideration of survival curves from the American Joint Committee on Cancer Melanoma Staging Database, the author of this E-Learning module provides a historic overview of the adjuvant melanoma treatment and the results from recent clinical trials with immunotherapy and targeted therapy.

By presenting an overview of timeline in the adjuvant melanoma treatment, the author shows a long period labelled by considerably different uptake and the guidelines for adjuvant interferon alpha, followed by recent spotlights on adjuvant ipilimumab, adjuvant anti-PD1 monoclonal antibodies nivolumab and pembrolizumab, as well as targeted monotherapy with BRAF inhibitor vemurafenib and dabrafenib/trametinib combination adjuvant therapy.

The author underlines that a combination of BRAF and MEK inhibitors has a role in the adjuvant setting for stage III BRAF V600 mutant melanoma. Nivolumab has a role in the adjuvant setting for stage IIIB, IIIC and resected stage IV melanoma, pembrolizumab shows efficacy in high-risk resected stage III melanoma, while ipilimumab showed less efficacy than nivolumab in the adjuvant setting. The author also questions whether adjuvant interferon alpha has still a role in the adjuvant treatment, in particular for ulcerated primary melanoma and presumes that it will probably soon be replaced with novel treatments.

Many therapeutic advances, with immune checkpoint inhibitors and targeted agents in patients with metastatic melanoma, prompted the research interest and testing in the adjuvant setting. In this E-Module the author not only summarises the evidence from the adjuvant clinical trials but puts emphasis on the shift towards the neoadjuvant setting as a new intense research area in melanoma.

This E-Learning module was published in 2018 and expired in 2021.

Last update: 12 Oct 2018

The author has reported to receive payment for consultancy and speaker honoraria from BMS, MSD, Novartis, F.Hoffman–La Roche

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