Stage 3A: Potential Benefits of Adjuvant Treatment

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Stage 3A: Potential Benefits of Adjuvant Treatment

It is important to know that adjuvant treatment may not be recommended for all patients with Stage 3A melanoma. Patients with a sentinel node metastasis of 1 mm or less have experienced little benefit from the treatment, and were not included in the original clinical trials. Your medical team should be able to help you with any questions you have about this.

Without Adjuvant Treatment 

Figure A: Stage 3A melanoma: melanoma specific survival without treatment

Stage 3A melanoma: melanoma specific survival 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 3A melanoma who are treated with surgery alone (and do not have adjuvant therapy), we would expect 93 people to still be alive five years after their melanoma surgery. This is 93% of individuals — shown in yellow.

After the same period (within five years of their surgery), seven people in the group will not have survived their melanoma. The melanoma will therefore have recurred (returned) and 7% of individuals will have sadly died due to it — shown in purple.

At ten years after surgery, 88% of people are still alive without adjuvant treatment. 12% 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 3A?

Research shows that adjuvant treatment can be between 10% – 50% effective at preventing a relapse after 5 years, dependent on the melanoma stage and the type of treatment given. 2,3,4

Figure B: Stage 3A Melanoma: Recurrence free at 5 years with adjuvant treatment. An example of adjuvant treatment with a 50% benefit

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.

Here is a diagram of how 50% effectiveness of adjuvant treatment would look for individuals at Stage 3A of melanoma using the same international melanoma database figures as in the diagram above.

Stage 3A Melanoma: Recurrence free at 5 years with adjuvant treatment. An example of adjuvant treatment with a 50% benefit diagram

NB: Data for 10 year recurrence free rates is currently not available. 

– 93 people 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.

– 3 or 4 people will 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 3 or 4 people (50% of 7) 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 increase from 93% to 96.5%.

As mentioned previously, research indicated that adjuvant treatment can be between 10-50% effective. If the treatment was 10% effective, the benefit would be smaller and would only translate to 0.7 people in 100 no longer having a relapse after 5 years due to adjuvant treatment. The melanoma free percentage at 5 years would only increase from 93% to 93.7%.

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. Hindié E. Adjuvant therapy in stage IIIA melanoma. Lancet Oncol. 2021 Jul;22(7):e299. doi: 10.1016/S1470-2045(21)00346-6. PMID: 34197759.

3. Dummer R, et al., Five-Year Analysis of Adjuvant Dabrafenib plus Trametinib in Stage III Melanoma. N Engl J Med. 2020 Sep 17;383(12):1139-1148. doi: 10.1056/NEJMoa2005493. Epub 2020 Sep 2. PMID: 32877599.

4. Eggermont AMM, et al., Longer Follow-Up Confirms Recurrence-Free Survival Benefit of Adjuvant  Pembrolizumab in High-Risk Stage III Melanoma: Updated Results From the EORTC 1325-MG/KEYNOTE-054 Trial. J Clin Oncol. 2020 Nov 20;38(33):3925-3936. doi: 10.1200/JCO.20.02110.

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.