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Mohr P, Kiecker F, Soriano V, Dereure O, Mujika K, Saiag P, Utikal J, Koneru R, Robert C, Cuadros F, Chacón M, Villarroel RU, Najjar YG, Kottschade L, Couselo EM, Koruth R, Guérin A, Burne R, Ionescu-Ittu R, Perrinjaquet M, Zager JS. Adjuvant therapy versus watch-and-wait post surgery for stage III melanoma: a multicountry retrospective chart review. Melanoma Manag 2019; 6:MMT33. [PMID: 31871622 PMCID: PMC6923782 DOI: 10.2217/mmt-2019-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/11/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To describe treatment patterns among patients with stage III melanoma who underwent surgical excision in years 2011-2016, and assess outcomes among patients who subsequently received systemic adjuvant therapy versus watch-and-wait. METHODS Chart review of 380 patients from 17 melanoma centers in North America, South America and Europe. RESULTS Of 129 (34%) patients treated with adjuvant therapy, 85% received interferon α-2b and 56% discontinued treatment (mostly due to adverse events). Relapse-free survival was significantly longer for patients treated with adjuvant therapy versus watch-and-wait (hazard ratio = 0.63; p < 0.05). There was considerable heterogeneity in adjuvant treatment schedules and doses. Similar results were found in patients who received interferon-based adjuvant therapy. CONCLUSION Adjuvant therapies with better safety/efficacy profiles will improve clinical outcomes in patients with stage III melanoma.
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Affiliation(s)
- Peter Mohr
- Department of Dermatology, Elbe Kliniken, Stade, Germany
| | - Felix Kiecker
- Department of Dermatology and Allergy, Skin Cancer Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Virtudes Soriano
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Olivier Dereure
- Department of Dermatology and INSERM U1058 ‘pathogenesis and control of chronic infections’, University of Montpellier, Montpellier, France
| | - Karmele Mujika
- Department of Medical Oncology, Onkologikoa-Oncology Institute Gipuzkoa, Gipuzkoa, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology Ambroise Paré Hospital, APHP; EA 4340 ‘Biomarkers in cancerology and hemato-oncology’, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany and Department of Dermatology, Venereology and Allergology; University Medical Center, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Rama Koneru
- RS McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Oshawa, Ontario, Canada
| | - Caroline Robert
- Dermatology Unit, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - Florencia Cuadros
- Medical Oncology, Instituto de Oncologia de Rosario, Rosario, Santa Fe, Argentina
| | - Matias Chacón
- Departments of Medical and Surgical Oncology, Instituto Alexander Fleming, Buenos Aires, Argentina
| | | | - Yana G Najjar
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lisa Kottschade
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Eva M Couselo
- Department of Medical Oncology, Vall d'Hebron Hospital and VHIO (Vall d'Hebron Institute of Oncology), Barcelona, Spain
| | - Roy Koruth
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | | | | | | | | | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL 33612, USA
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10
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Hauschild A, Weichenthal M, Rass K, Linse R, Ulrich J, Stadler R, Volkenandt M, Grabbe S, Proske U, Schadendorf D, Brockmeyer N, Vogt T, Rompel R, Kaufmann R, Kaatz M, Näher H, Mohr P, Eigentler T, Livingstone E, Garbe C. Prospective Randomized Multicenter Adjuvant Dermatologic Cooperative Oncology Group Trial of Low-Dose Interferon Alfa-2b With or Without a Modified High-Dose Interferon Alfa-2b Induction Phase in Patients With Lymph Node–Negative Melanoma. J Clin Oncol 2009; 27:3496-502. [DOI: 10.1200/jco.2008.21.3892] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeInterferon alfa (IFN-α) has shown clinical efficacy in the adjuvant treatment of patients with high-risk melanoma in several clinical trials, but optimal dosing and duration of treatment are still under discussion. It has been argued that in high-dose IFN-α (HDI), the intravenous (IV) induction phase might be critical for the clinical benefit of the regimen.Patients and MethodsIn an attempt to investigate the potential role of a modified high-dose induction phase, lymph node–negative patients with resected primary malignant melanoma of more than 1.5-mm tumor thickness were included in this prospective randomized multicenter Dermatologic Cooperative Oncology Group trial. Six hundred seventy-four patients were randomly assigned to receive 4 weeks of a modified HDI scheme. This schedule consisted of 5 times weekly 10 MU/m2IFN-α-2b IV for 2 weeks and 5 times weekly 10 MU/m2IFN-α-2b administered subcutaneously (SC) for another 2 weeks followed by 23 months of low-dose IFN-α-2b (LDI) 3 MU SC three times a week (arm A). LDI 3 MU three times a week was given for 24 months in arm B.ResultsOf 650 assessable patients, there were 92 relapses among the 321 patients receiving high-dose induction as compared with 95 relapses among the 329 patients receiving LDI only. Five-year relapse-free survival rates were 68.0% (arm A) and 67.1% (arm B), respectively. Likewise, melanoma-related fatalities were similar between both groups, resulting in 5-year overall survival rates of 80.2% (arm A) and 82.9% (arm B).ConclusionThe addition of a 4-week modified HDI induction phase to a 2-year low-dose adjuvant IFN-α-2b treatment schedule did not improve the clinical outcome.
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Affiliation(s)
- Axel Hauschild
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Michael Weichenthal
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Knuth Rass
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Ruthild Linse
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Jens Ulrich
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Rudolf Stadler
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Matthias Volkenandt
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Stephan Grabbe
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Ulrike Proske
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Dirk Schadendorf
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Norbert Brockmeyer
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Thomas Vogt
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Rainer Rompel
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Roland Kaufmann
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Martin Kaatz
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Helmut Näher
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Peter Mohr
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Thomas Eigentler
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Elisabeth Livingstone
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
| | - Claus Garbe
- From the Departments of Dermatology at University of Kiel, Kiel; University of Homburg/Saar, Homburg; Helios Klinikum Erfurt, Erfurt; University of Magdeburg, Magdeburg; Johannes Wesling Hospital Minden, Minden; University of Munich, Ludwig-Maximilians-Universität, Munich; University of Mainz, Mainz; University of Essen, Essen; University of Dresden, Dresden; University of Mannheim, Mannheim; University of Bochum, Bochum; University of Regensburg, Regensburg; Municipal Hospital Kassel, Kassel; University
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