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. 2020 Feb:126:159-177.
doi: 10.1016/j.ejca.2019.11.015. Epub 2019 Dec 19.

European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019

Claus Garbe  1 , Teresa Amaral  2 , Ketty Peris  3 , Axel Hauschild  4 , Petr Arenberger  5 , Lars Bastholt  6 , Veronique Bataille  7 , Veronique Del Marmol  8 , Brigitte Dréno  9 , Maria Concetta Fargnoli  10 , Jean-Jacques Grob  11 , Christoph Höller  12 , Roland Kaufmann  13 , Aimilios Lallas  14 , Celeste Lebbé  15 , Josep Malvehy  16 , Mark Middleton  17 , David Moreno-Ramirez  18 , Giovanni Pellacani  19 , Philippe Saiag  20 , Alexander J Stratigos  21 , Ricardo Vieira  22 , Iris Zalaudek  23 , Alexander M M Eggermont  24 ; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC)
Affiliations
Free article

European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019

Claus Garbe et al. Eur J Cancer. 2020 Feb.
Free article

Abstract

A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies in stage III/IV patients are primarily anti-PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.

Keywords: Adjuvant treatment; Cutaneous melanoma; Excisional margins; Interferon-α; Metastasectomy; Sentinel lymph node dissection; Systemic treatment; Tumour thickness.

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Conflict of interest statement

Conflict of interest statement C.G. reports receiving personal fees from Amgen, Pierre Fabre, Philogen and MSD; and reports receiving grants and personal fees from Novartis, NeraCare, BMS, Roche and Sanofi, outside the submitted work. T.A. reports receiving personal fees and other grants from BMS, Novartis, Pierre Fabre, Neracare and Sanofi, outside the submitted work. K.P. reports receiving personal fees from Novartis, Roche, Sanofi, Lilly, Leopharma, Pierre Fabre, Almirall and Celgene, outside the submitted work. A.H. reports receiving grants and personal fees from Amgen, BMS, MerckSerono, MSD / Merck, Philogen, Pierre Fabre, Provectus, Regeneron, Roche, Sanofi-Genzyme, and Novartis Pharma; receiving personal fees from OncoSec and Sun Pharma, outside the submitted work. P.A. reports receiving personal fees from Amgen, MSD, Novartis, BMS and Roche, outside the submitted work. L.B. reports receiving grants from BMS, during the conduct of the study; personal fees from BMS, Novartis, MerckMSD, Roche, Incyte, Bayer, outside the submitted work. V.B. reports receiving personal fees from Novartis and MerckMSD, outside the submitted work. V.d.M. reports receiving personal fees from MSD, BMS and Sanofi; grants and personal fees from ABVIE; grants from Jansen, outside the submitted work. B.M. reports grants and personal fees from BMS, Roche, Fabre and Sanofi; personal fees from MSD, outside the submitted work. M.C.F. reports receiving grants and personal fees from Almirall, Leo Pharma, Novartis, Sanofi, Abbvie and Galderma; personal fees from Janssen, Lilly, UCB, Celgene, Pierre Fabre, Mylan, Medac Pharma, Roche, Sun Pharma, outside the submitted work. J.J.G. reports receiving personal fees from Amgen, MSD, Novartis, BMS, Roche, Pierre fabre, MercK / Pfizer, outside the submitted work. C.H. reports receiving personal fees from Amgen, MSD, Novartis, Incyte, BMS, Pierre Fabre, Roche, Sanofi, outside the submitted work. R.K. reports receiving grants and personal fees from Novartis and Roche; and grants from AbbVie, Amgen, Bionteck, BMS, Celgene, Galderma, Janssen, Leo, Lilly, Merck, MSD, Pierre Fabre, Regeneron and Wyeth, outside the submitted work. A.L. reports personal fees from Amgen, Novartis, BMS and ,Sanofi grants and personal fees from Roche, outside the submitted work. C.L. reports receiving grants and personal fees from Bristol-Myers Squibb and Roche; personal fees from MSD, Novartis, Amgen, Avantis Medical Systems, Pierre Fabre, Pfizer, Incyte, outside the submitted work. J.M. reports personal fees from Amgen, personal fees from MSD, grants from Novartis, grants and personal fees from BMS, grants and personal fees from Roche, grants and personal fees from Almirall, personal fees from Sun Pharma, outside the submitted work. M.M. reports receiving personal fees from Amgen and BiolineRx; grants and personal fees from Roche and GSK; grants from Astrazeneca; personal fees and other from Novartis, Eisai, Array Biopharma (now Pfizer), Rigontec (acquired by MSD), and BMS; other from Millennium, RegeneronPfizer; personal fees, non-financial support and other from Immunocore, Replimun and Merck / MSD, outside the submitted work. D.M-.R. has nothing to disclose. G.P. reports receiving personal fees from Novartis, personal fees from Sanofi, grants from Novartis, instruments from 3Gen, Vidix, Fotofinder and MAVIG GmbH, outside the submitted work. P.S. reports receiving personal fees from Amgen, MSD and Pierre Fabre / array; grants and personal fees from Novartis, NeraCare, BMS, Roche, and Sanofi, outside the submitted work. A.J.S. reports personal fees and/or research support from Novartis, Roche, BMS, Abbvie, Sanofi, Regeneron, Genesis Pharma, outside the submitted work. Dr. Vieira has nothing to disclose. I.Z. reports receiving personal fees from Difa Cooper, MSD, Sanofi, Almirall Hermal, Novartis, Mylan and Sunpharma; grants and personal fees from Roche, outside the submitted work. A.M.M.E. reports receiving personal fees from Biocad, Biovent, BMS, CatalYm, Ellipses, GSK, Incyte, IO Biotech, ISA Pharmaceuticals, MerckGmbH, MSD, Novartis, Pfizer, Polynoma, Regeneron, Sanofi, SkylineDx, Stellas; other from RiverD, SkylineDx, Theranovir, all outside the submitted work.