Immunotherapy treatment with ipilumimab after resection of high-risk melanoma improves overall survival compared to no treatment.
In high risk melanoma lesions where a cutaneous melanoma has spread to local lymph nodes, despite surgical resection, only about 45% of patients will not have the melanoma come back within 4 years. Currently, there are no great medical options for treatment to improve these odds.
Ipilumimab was the first immunotherapy approved for treatment of metastatic melanoma and works by blocking cytotoxic T-lymphocyte antigen 4 (CTLA-4) to increase the immune system effect of identifying and killing cancer cells. In this phase 3 EORTC 18071 trial, patients with stage III melanoma after surgery were randomized to receive either ipilumimab or placebo. In results just published in New England Journal of Medicine, patients who received ipilumimab lived longer than those in the placebo group. The survival rate at 5 years was 65% compared to 54$ in the placebo group. Ipilumimab does have significant side effects including rash, diarrhea, colitis, liver inflammation and endocrinopathies. Usually these side effects are reversible with steroids. Therefore, the potential benefits must be weighed against potential side effects in a personalized discussion with your oncologist. Further trials are looking at other immunotherapies in this setting, but this is the first published result to ever have this significant an improvement in survival after resection in high-risk melanoma.