Pros and Cons of Adjuvant Interferon in the Treatment of Melanoma

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Abstract
Learning Objectives: After completing this course, the reader will be able to: Define the indication for and administration of IFN-α in the adjuvant treatment of melanoma. Explain the rationale both for and against the use of adjuvant interferon. Discuss areas of ongoing research for adjuvant therapy of melanoma. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Should interferon alpha (IFN-α) 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-α. Conflicting data from several large, randomized clinical trials resulted in a rapid rise and then decline in the use of IFN-α in the adjuvant setting. This roller coaster has left many clinicians still hesitant to strongly recommend it, and the use of adjuvant IFN-α 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.