Stage 2B: Potential Benefits of Adjuvant Treatment

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Stage 2B: Potential Benefits of Adjuvant Treatment

Without Adjuvant Treatment

Figure A: Stage 2B Melanoma: melanoma specific survival of stage 2B melanoma patients without treatment

Melanoma specific survival of stage 2B melanoma patients without treatment diagram

Figure A explanatory: The diagram above shows data for melanoma patients 5 years and 10 years after receiving a melanoma diagnosis. It is based on a study using a global; international melanoma database from ten countries (Eighth Edition International Melanoma Database)¹ It shows how many patients are likely to survive (still be alive) 5 years and 10 years after receiving their melanoma diagnosis.

For 100 people diagnosed with Stage 2B melanoma who are treated with surgery alone (and do not have adjuvant therapy), we would expect 87 people to still be alive five years after their melanoma surgery. This is 87% of individuals — shown in yellow.

After the same period (within five years of their surgery), thirteen people in the group will have not survived their melanoma. The melanoma will therefore have recurred (returned) and 13% of individuals will have sadly died due to it — shown in purple.

At ten years after surgery, 82% of people are still alive without adjuvant treatment. 18% of people will sadly not have survived their melanoma – shown in purple.

With Adjuvant Treatment

What is the potential benefit of adjuvant treatment at Stage 2B?

Adjuvant treatment with pembrolizumab for Stage 2B/C melanoma can reduce the risk of recurrence by at least 35%².Further research is looking at outcomes for patients treated with pembrolizumab or other adjuvant options. It is possible the benefit from adjuvant therapy may be greater. Your melanoma team will be able to discuss your risk of recurrence and your likely benefit from adjuvant therapy.

Figure B: Stage 2B Melanoma: Predicted improvement five-years after adjuvant therapy associated with a 40% risk-reduction

Here we use the term recurrence free meaning the amount of people whose melanoma has not come back after 5 years. This is used in place of survival (the amount of people who are alive) in some clinical trials until we have longer term survival information.

Stage 2B: Predicted improvement five-years after adjuvant therapy associated with a 40% risk-reduction diagram

The illustration shows the effect a treatment associated with a 40% risk-reduction might have for individuals with Stage 2B melanoma using the same international melanoma database figures as in the figure A diagram.

– 87 people out of 100 would be alive after their surgery and for illustrative purposes we are assuming that they would not be expected to have further problems from their melanoma. This means that the adjuvant therapy will not change what is going to happen to their melanoma and they may experience side effects from an unnecessary treatment. However, we have no way of identifying who these people are.

– 8 people of that 100 are likely to still go on to have further problems from their melanoma even though they had the adjuvant therapy. This means that the adjuvant therapy HAS NOT changed what has happened to their melanoma.

– However, an extra 5 people (40% of 13) would be expected NOT to have further problems from their melanoma. For this group, the adjuvant therapy HAS changed what has happened to their melanoma.

The number of people melanoma free at 5 years would be predicted to increase from 87% to 92%.

Initial research indicates that adjuvant treatment reduces the risk of recurrence of Stage 2 melanoma by at least 35%² and the benefit may be greater than this. It is likely that more will be known about the potential benefits of adjuvant treatment in the near future.

For further information on the types of adjuvant treatments and the potential side effects, see here.

References

1.Gershenwald JE et al., Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017 Nov;67(6):472-492. doi: 10.3322/caac.21409. Epub 2017 Oct 13. PMID: 29028110; PMCID: PMC5978683

2. Luke JJ et al. Pembrolizumab versus placebo as adjuvant therapy in completely resected stage IIB or IIC melanoma (KEYNOTE-716): a randomised, double-blind, phase 3 trial: https://doi.org/10.1016/S0140-6736(22)00562-1

Adjuvant treatment guide by Melanoma stage

The potential benefits and risks for adjuvant treatment vary by stage. Please select your melanoma stage from the links below to see the correct information.