No evidence that interferon is necessary or helpful for patients with melanoma with minimal metastasis to the lymph nodes, according to the final results of the Sunbelt Melanoma Trial, published online ahead of print in the Journal of Clinical Oncology.1
FDA approval of interferon for melanoma was based on a study of patients with multiple large, palpable lymph nodes involved in their cancer; however, sentinel lymph node (SLN) biopsy allows clinicians to detect significantly smaller amounts of cancer in lymph nodes. Most patients with melanoma metastasis to the lymph nodes have cancer only in 1 lymph node. Their disease is considered stage III because it is in the lymph nodes, but the smaller amounts of cancer indicate a lower risk of recurrence.
The Sunbelt Trial was conducted to determine if interferon therapy, which is 1 of 2 drugs FDA-approved for adjuvant therapy for high-risk melanoma, is necessary for these patients. Interferon therapy is described as similar to having the flu, only worse, for a whole year.
Patients enrolled in the Sunbelt Trial had microscopic amounts of melanoma detected in a single node via SLN biopsy or disease detected at the molecular level via polymerase chain reaction (PCR). Although the study was underpowered to detect very small differences in survival, the researchers did not even see a trend for improvement in survival with interferon therapy.
In practice, most patients have the smaller level of cancer in the lymph nodes. Therefore, recommending interferon therapy for patients with minimal cancer in only 1 lymph node is hard. The investigators believe “options now in the pipeline and further research into the molecular behavior of cancer cells will reveal more advantageous treatments for those with limited lymph node metastases.”
1. University of Louisville. Interferon not beneficial for most stage III melanoma [press release]. EurekAlert! Web site. http://www.eurekalert.org/pub_releases/2016-02/uol-inb021216.php. Posted February 15, 2016. Accessed February 16, 2016.