Safety and effectiveness of different therapies after surgery for patients with resected melanoma.

This study compared how safe and effective are different therapies after surgery in patients with melanoma. This study showed that nivolumab had the best outcome for patients with melanoma following surgery.

Melanoma is a type of skin cancer. First line therapy for melanoma involves surgery to remove the tumor. Surgery is effective for most patients with early-stage melanoma. Some patients have a spread of the tumor to other areas (metastasis). In these patients, the tumor can reappear after surgery (recurrent melanoma). These patients need additional therapy (adjuvant therapy).

Options for adjuvant therapy include radiotherapy (RT), immunotherapy (IT), and targeted therapy (TT). RT uses high-energy radiation to kill cancer cells by damaging their DNA. IT switches on the patient’s own immune system to target and kill cancer cells. TT is used to identify and attack cancer cells based on the proteins they express.

Different types of IT are used to treat melanoma. Immune checkpoint inhibitors remove the ‘breaks’ on the immune system. They include ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda). TT options include a combination of dabrafenib (Tafinlar) and trametinib (Mekinist).

It is not yet clear which of these options is best for the treatment of patients with melanoma following surgery.

This study evaluated 19 randomized clinical trials. These trials included patients who had surgery to remove a melanoma tumor. The study compared patients who were given nivolumab with patients who were given pembrolizumab, ipilimumab, or dabrafenib + trametinib.

The risk of patients developing recurrent melanoma was lower in the nivolumab group than in the ipilimumab group. After 1 year, the risk of recurrence was similar between the nivolumab and dabrafenib+trametinib group. However, the risk of recurrence was 54% lower in the nivolumab group than in the dabrafenib + trametinib group 2 years after treatment. There was no difference in recurrence rates between the nivolumab and pembrolizumab groups.

Patients in the nivolumab group also reported lower rates of side effects compared to other therapies.

This study concluded that nivolumab is a safe and effective after surgery for patients with resected melanoma. 

This article pooled results from different studies with different protocols. It is not clear if the control group in each of the clinical trials had the same treatment.