Pembrolizumab in the adjuvant treatment of melanoma: efficacy and safety

ABSTRACT

Introduction: Regional or distant metastases from melanoma may be surgically resected but remain at high-risk of recurrence. Over the last few years, several treatments have been approved to mitigate this risk. These include anti-PD-1 agents, specifically pembrolizumab and nivolumab.

Areas covered: Herein, we will discuss the landscape of pembrolizumab safety and efficacy used in the adjuvant setting for high-risk, resected melanoma. We place this in context with other available adjuvant therapies, and discuss subgroup analyses.

Expert opinion: Anti-PD-1 therapy with either pembrolizumab or nivolumab has become a standard of care for patients with resected stage III or IV melanoma. In our practice, we generally offer these agents (which have comparable safety and efficacy profiles) to patients with resected stage IIIb–IV melanoma regardless of BRAF mutation status.

KEYWORDS:

• Pembrolizumab
• nivolumab
• melanoma
• adjuvant
• resection

Article highlights

• Pembrolizumab as an adjuvant therapy improves relapse-free survival (RFS) in patients with resected stage III melanoma.

• The impact of overall survival for adjuvant anti-PD-1 has not yet been defined.

• Patients with immune-related adverse events (irAEs) experience superior RFS compared with patients not experiencing irAEs.

• The choice of adjuvant therapies depends on dose and schedule considerations, patient comorbidities, and for some physicians, BRAF mutation status.

Declaration of interest

DB Johnson declares serving on advisory boards for Array Biopharma, Bristol Myers Squibb, Genoptix, Iovance, Jansen, Novartis, Merck, and providing research support from Bristol Myers Squibb and Incyte.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported in part by NIH/NCI F32 CA254070-01 (CA Nebhan), NIH/NCI K23 CA204726 (DBJ), James C. Bradford Jr. melanoma fund (DB Johnson)