New England Journal of Melanoma.

The NEJM published three big trials looking at adjuvant or definitive targeted therapy for stage III melanoma patients, patients who haven’t gotten many invites to the immunotherapy party for metastatic disease. For those with BRAF V600E/K mutated completely resected stage III disease, adjuvant dabrafenib and trametinib improved relapse-free survival by almost 20% and overall survival by 10% (though not technically meeting interim analysis significance). The second trial was more inclusive by assessing all completely resected stage III-IV disease and showed that adjuvant nivolumab both improved recurrence-free survival by 10% and was less toxic than ipilimumab. Finally, the 3 year results of CheckMate 067 showed that nivo or nivo+ipi improved overall survival for unresectable BRAF V600 mutated stage III-IV patients by around 20% compared to ipi alone. NCCN currently recommends ipilimumab, interferon, observation, or clinical trials for stage III melanoma so this immunotherapy data party of three should be practice changing. Stay tuned.