Adjuvant immunotherapy in the modern management of resectable melanoma: current status and outlook to 2028

Abstract

Background: Therapeutic advances have reshaped the treatment landscape for patients with resectable melanoma, particularly for those with stage IIB/C and stage III disease. In this article, we discuss the current status and future outlook of adjuvant immunotherapy for melanoma in Europe.

Results: Adjuvant immunotherapy offers significant benefits in terms of recurrence-free survival and distant metastasis-free survival. Uncertainties regarding overall survival (OS) benefits, however, remain. Trials such as Keynote-054, which are expected to provide crucial OS information, have delayed their final analyses until 2027. Additionally, real-world studies have raised questions about the correlation between recurrence-free survival/distant metastasis-free survival improvements observed in clinical trials and OS outcomes in routine clinical practice. These uncertainties have led to ongoing debates about the cost-effectiveness of adjuvant therapies, with disparities in reimbursement policies across Europe reflecting these concerns.

Conclusion: Looking ahead to 2028, adjuvant immunotherapy will remain a key option of comprehensive melanoma care, particularly for patients with stage IIB/C and stage III with micrometastatic disease, where neoadjuvant immunotherapy is not feasible.

Keywords: adjuvant therapy; approval; immunotherapy; melanoma; neoadjuvant therapy.

Figure 1

Reimbursement of adjuvant anti-PD-1 for melanoma across Europe. Information to generate Figure 1 was provided by the authors of this article or by internet search in the official websites of national healthcare agencies in August 2024. Figure template was obtained from https://slidelizard.com/en/blog/powerpoint-world-map (accessed on 1 July 2024). Geographical borders of Europe were drawn by the corresponding authors. PD-1, programmed cell death protein 1. ^aNot reimbursed for stage IIIB. ^bFull pharmacoeconomic assessment for stage IIB/C ongoing. ^cReimbursed for stage IIC but not IIB.