The likelihood of the primary cutaneous melanoma to metastasize mainly depends on thickness, presence of ulceration and mitotic rate. If patients have a positive sentinel node or develop palpable lymph node metastasis, RLND is potentially curative, although the survival is poor. The 5-year survival rate ranges between 27% and 69%, depending on the size and number of involved nodes and characteristics of the pri- mary melanoma.7 In case of metastatic melanoma the prog- nosis is poor, despite recent therapeutic developments such as targeted therapies and immune checkpoint inhibitors and their positive impact on OS.
This has initiated numerous trials over the last few decades in search of an effective adju- vant treatment in early stage high-risk melanoma (stage IIB, IIC and III). Adjuvant radiotherapy after RLND can be considered for patients with extranodal extension, incomplete surgery or numerous positive lymph nodes to improve regional control, however, without any recurrence-free sur- vival (RFS) or OS benefit.
Adjuvant treatment with DC vaccination after RLND in patients with regional metastasis of melanoma is safe and results in a favorable OS compared to matched controls. Importantly, DC vaccination is well tolerated and clearly less toxic than adjuvant IFN-a or ipilimumab. These results suggest that DC vaccination has efficacy as adjuvant treatment of melanoma, and provide further support to test this in a prospec- tive randomized clinical trial.
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Scientific article publishing date : 15/1/2016
Immucura identifier : BSC21_019EN