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Pros and Cons of Adjuvant Interferon in the Treatment of Melanoma

University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA

Correspondence: Michael S. Sabel, M.D., University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109, USA. Telehone: 734-936-5827; Fax: 734-647-9647; e-mail: msabel{at}umich.edu

Should interferon alpha (IFN-) be considered the standard of care for the adjuvant therapy of high-risk malignant melanoma? For 2003, it was estimated that 51,400 cases of invasive melanoma would be diagnosed. The risk of recurrence after surgery is reported to be approximately 60% for patients with thick primary lesions (T4N0M0, American Joint Committee on Cancer [AJCC] stage IIB) and 75% for patients with regional nodal metastases (T1-4N1M0, AJCC stage III). The observation that melanoma is susceptible to attack by the host’s immune system has resulted in the testing of a remarkably broad spectrum of immunotherapies in the adjuvant setting. Many of these approaches failed to demonstrate a significant clinical impact, until the use of adjuvant IFN-. Conflicting data from several large, randomized clinical trials resulted in a rapid rise and then decline in the use of IFN- in the adjuvant setting. This roller coaster has left many clinicians still hesitant to strongly recommend it, and the use of adjuvant IFN- in high-risk melanoma remains controversial. This manuscript reviews the leading arguments for and against its routine use and addresses questions regarding its role in the management of high-risk malignant melanoma.

Key Words. Interferon • Melanoma • Adjuvant

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