Systemic adjuvant therapy for adult patients at high risk for recurrent cutaneous or mucosal melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline

  • T. M. Petrella University of Toronto and Odette Cancer Centre, Sunnybrook Health Sciences Centre
  • G. G. Fletcher Ontario Health (Cancer Care Ontario), McMaster University
  • G. Knight McMaster University, Grand River Regional Cancer Centre,
  • E. McWhirter McMaster University, Juravinski Cancer Centre
  • S. Rajagopal Credit Valley Hospital
  • X. Song University of Ottawa, Ottawa, ON and The Ottawa Hospital Cancer Centre
  • T. D. Baetz Queen’s University, Cancer Centre of Southeastern Ontario/Kingston General Hospital
Keywords: Melanoma, adjuvant therapy, immune checkpoint inhibitors, targeted therapy, interferon, practice guideline

Abstract

Background Previous versions of the guideline from the Program in Evidence-Based Care (pebc) at Ontario Health (Cancer Care Ontario) recommended that the use of high-dose interferon alfa 2b therapy be discussed and offered to patients with resected cutaneous melanoma with a high risk of recurrence. Subsequently, several clinical trials in patients with resected or metastatic melanoma found that immune checkpoint inhibitors and targeted therapies have a benefit greater than that with interferon. It was therefore considered timely for an update to the guideline about adjuvant systemic therapy in melanoma.

Methods The present guideline was developed by the pebc and the Melanoma Disease Site Group (dsg). Based on a systematic review from a literature search conducted using medline, embase, and the Evidence Based Medicine Reviews databases for the period 1996 to 28 May 2019, the Working Group drafted recommendations. The systematic review and recommendations were then circulated to the Melanoma dsg and the pebc Report Approval Panel for internal review; the revised document underwent external review.

Recommendations For patients with completely resected cutaneous or mucosal melanoma with a high risk of recurrence, the recommended adjuvant therapies are nivolumab, pembrolizumab, or dabrafenib–trametinib for patients with BRAF V600E or V600K mutations; nivolumab or pembrolizumab are recommend for patients with BRAF wildtype disease. Use of ipilimumab is not recommended. Molecular testing should be conducted to help guide treatment decisions. Interferon alfa, chemotherapy regimens, vaccines, levamisole, bevacizumab, bacillus Calmette–Guérin, and isolated limb perfusion are not recommended for adjuvant treatment of cutaneous melanoma except as part of a clinical trial.

Author Biographies

G. G. Fletcher, Ontario Health (Cancer Care Ontario), McMaster University

Program in Evidence-Based Care, Department of Oncology

G. Knight, McMaster University, Grand River Regional Cancer Centre,
Department of Oncology
E. McWhirter, McMaster University, Juravinski Cancer Centre
Department of Oncology, Division of Medical Oncology
X. Song, University of Ottawa, Ottawa, ON and The Ottawa Hospital Cancer Centre
Department of Internal Medicine, Division of Medical Oncology
T. D. Baetz, Queen’s University, Cancer Centre of Southeastern Ontario/Kingston General Hospital
Department of Oncology
Published
2020-03-06
How to Cite
Petrella, T. M., Fletcher, G. G., Knight, G., McWhirter, E., Rajagopal, S., Song, X., & Baetz, T. D. (2020). Systemic adjuvant therapy for adult patients at high risk for recurrent cutaneous or mucosal melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline. Current Oncology, 27(1). https://doi.org/10.3747/co.27.5933
Section
Practice Guideline