Evaluating the outcomes of current therapies after surgery for patients with stage III melanoma who did not undergo complete lymph node dissection.

This study evaluated the outcomes of immune and molecular targeted therapies after surgery for patients with stage III melanoma who did not undergo complete lymph node dissection. The data showed that the immune and targeted therapies after surgery were associated with increased survival without metastasis among these patients.

In advanced melanoma, the sentinel lymph node (SLN) is the first lymph node to which the cancer cells are believed to have spread (metastasis). The presence of SLN is determined by a procedure called sentinel lymph node biopsy (SLNB). It involves taking a tissue sample to determine whether the cancer has spread to the nearby lymph nodes. Patients who are found to have cancerous SLN undergo complete lymph node dissection (CLND – removal of the lymph nodes). However, studies showed that CLND does not improve overall survival in patients with a positive SLNB.

Immunotherapy like pembrolizumab (Keytruda) and ipilimumab (Yervoy) and targeted therapies like dabrafenib (Tafinlar) plus trametinib (Mekinist) have been found to be effective in advanced melanoma. However, whether immune and targeted therapies after surgery for patients with stage III melanoma, with a positive SLNB who did not undergo CLND improve their outcomes, is still under investigation.

This study involved 90 patients with stage III melanoma who did not undergo CLND. Patients were divided into 2 groups according to the treatment they received after surgery. Group 1 included 56 patients who were treated with immune or targeted therapies after surgery. Group 2 included 34 patients who underwent observation alone. The average follow-up time was 19 months.

11 (20%) patients in group 1 had disease recurrence compared to 12 (35%) patients in group 2.

After 2 years, 86% of patients in group 1 were alive without distant metastasis compared to 59% of patients in group 2.

The nodal recurrence rate was 26% in group 1 compared to 20% in group 2. After 2 years, 75% of patients in group 1 were alive without nodal recurrence compared to 61% of patients in group 2. These differences were not significant.

This study concluded that immune and targeted therapies after surgery were associated with increased survival without metastasis among patients with stage III melanoma who did undergo CLND.

This study looked back in time at medical records. The sample size was very small. Larger studies are needed.