How is adjuvant therapy given?

Table Of Contents

• Options for Stage II Melanoma: Making the Decision That’s Right For You
• What is Stage II melanoma?
• Is Stage II melanoma at high risk for coming back (recurring)?
• It is true that Stage II melanoma can have a worse prognosis than Stage III melanoma?
• How can I lower the risk of Stage II melanoma coming back? What adjuvant drugs are used?
• What are the side effects of adjuvant therapy?
• How is adjuvant therapy given?
• How do you weigh the benefits and risks of adjuvant therapy vs active surveillance?
• What do you tell patients who have Stage IIA melanoma and are worried about their risk for recurrence?

Dr. Geoffrey Lim: What’s it like to take these immunotherapies? Is it a pill or an infusion? How often is it given and for how long?

Dr. Jason Luke: The treatment with pembrolizumab is an intravenous (by vein) infusion. It can be given every three weeks or every six weeks. So, in my practice, we usually do the every-three-weeks regimen to start out because I want to make sure people are feeling okay and they’re not having any side effects. I believe it is very important to see people in person and have that interaction to make sure that we’re doing okay. And then if people are doing just fine, we sometimes stretch it to six-week intervals later on. But this varies by practice. Some people go straight to every six weeks right off the bat, and it’s not good or bad. Again, I start on the three-week interval before switching to a six-week interval just to make sure that I’m having very close communication with people because just like any medicine, you’re more likely to get side effects at the beginning when you start it, and we want to make sure we’re not missing anything.

We give pembrolizumab for up to one year unless patients get an intolerable side effect or have a recurrence, in which case we stop the drug and reevaluate what to do.

Suggested Reading
Khan S, Gerber DE. Autoimmunity, checkpoint inhibitor therapy and immune-related adverse events: A review. Semin Cancer Biol. 2020;64:93-101. doi:10.1016/j.semcancer.2019.06.012. Epub 2019 Jul 19. PMID: 31330185; PMCID: PMC6980444

Luke JJ, Rutkowski P, Queirolo P, et al. Pembrolizumab versus placebo as adjuvant therapy in completely resected stage IIB or IIC melanoma (KEYNOTE-716): a randomised, double-blind, phase 3 trial. Lancet. 2022;399(10336):1718-1729. doi:10.1016/S0140-6736(22)00562-1