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Fig. 2 | Journal for ImmunoTherapy of Cancer

Fig. 2

From: An update on the Society for Immunotherapy of Cancer consensus statement on tumor immunotherapy for the treatment of cutaneous melanoma: version 2.0

Fig. 2

Stage III N1a (7th)/Stage IIIA (8th) melanoma immunotherapy treatment algorithm. The consensus of the panel was to separate Stage III N1a (based on AJCC 7th edition) and Stage IIIA (AJCC 8th) from other Stage III subsets based on lower risk of metastatic potential. However, a minority (30%) felt that all Stage III patients should be treated similarly. All treatment options shown may be appropriate and final selection of therapy should be individualized based on patient eligibility and treatment availability at the physician’s discretion. These algorithms represent consensus sequencing suggestions by the panel. (1) There are limited data on the role of adjuvant therapy following sentinel lymphadenectomy alone, which is anticipated to become more common. (2) There is Level A evidence to support the use the combination of dabrafenib and trametinib in patients with BRAF V600E/K mutant, Stage III melanoma independent of the volume of lymph node involvement or the number of lymph nodes involved. (3) Level A data supporting the use of nivolumab over ipilimumab was demonstrated in patients with Stage IIIB to IV resected melanoma and did not include patients with Stage IIIA (based on 7th) disease. Ipilimumab 10 mg/kg dosing was supported by a minority of panelists (10%), however, subset analysis suggests that the risk: benefit ratio for patients with Stage IIIA melanoma does not support its use in Stage IIIA patients at this time. (4) There are level A data that 1 year interferon-α2b is associated with improvement in RFS and, while this therapy was generally recommended by the consensus panel previously, only two panelists recommended considering this therapy. There are level B data to support a benefit in RFS for pegylated-interferon-α2b in patients with N1a disease and in patients with ulceration of the primary tumor site; however, no panelists considered this a reasonable option for these patients. Abbreviations: LDH, lactate dehydrogenase; NCCN, National Comprehensive Cancer Network; RFS, recurrence-free survival

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