Adjuvant Therapy

ADJUVANT THERAPIES 

Early melanoma that has not spread beyond the skin or nearby lymph nodes is usually treated with surgery. Adjuvant therapy is additional cancer treatment given after the primary treatment (surgery), to lower the risk that the cancer will come back. Stage III patients that have had surgery and are considered to have no further evidence of disease (fully resected), still may be at higher risk for recurrence of melanoma.

Adjuvant therapy or clinical trials are typically offered to stage III patients after they have had a complete surgical resection of their melanoma. Please consult with your medical team to determine current treatments or clinical trials available for stage III patients.

The Following adjuvant therapies have been approved for funding in Canada:

The following adjuvant therapies are being considered in Canada:

nivolumab (Opdivo) has received a final positive recommendation from pCODR, (the pan-Canadian Oncology Drug Review), and INESSS, subject to price negotiations between provinces and the manufacturer.Individuals with private insurance may have access now. For individuals without private insurance, the manufacturer is providing interim compassionate access – please check with your oncology team for details. 

Individuals with private insurance may have access now. For individuals without private insurance, the manufacturer is providing interim compassionate access – please check with your oncology team for details. 

View the CADTH pan-Canadian Oncology Drug Review Details:

dabrafenib (Tafinlar) + trametinib (Mekinist) a positive recommendation from pCODR, (the pan-Canadian Oncology Drug Review), for the adjuvant treatment of patients with stage IIIA (limited to lymph node metastases of > 1 mm) to stage IIID (8th edition of the American Joint Committee on Cancer [AJCC] staging system) BRAF-mutated (all BRAF V600 mutations) cutaneous melanoma. Price negotiations between provinces and the manufacturer are still pending the final recommendation.

View the CADTH pan-Canadian Oncology Drug Review Details:

View press release “now reimbursed in Quebec for adjuvant melanoma patients with BRAF V600 mutation and lymph node involvement”

pembrolizumab (Keytruda) waiting for recommendations for adjuvant use.

Types of Adjuvant Therapy Treatments


Nivolumab (Opdivo) This is an immune checkpoint inhibitor that targets PD-1, a protein on immune system cells (called T cells) that normally help keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against melanoma cells. This can often shrink tumours and help people live longer. Learn more about immunotherapies.

Dabrafenib (Tafinlar) + trametinib (Mekinist) help prevent melanoma that has a certain type of abnormal “BRAF” gene from coming back after the cancer has been removed by surgery. Dabrafenib acts as an inhibitor of the BRAF protein and slows down or stops the growth of cancer cells while trametinib acts against the MEK protein. Both BRAF and MEK are key molecules that help regulate cell growth. A BRAF mutation signals cells, via MEK, to develop abnormally and divide out of control and grow into a melanoma tumour.  Learn more about targeted therapies.

Pembrolizumab (Keytruda) This drug is an immune checkpoint inhibitor that targets PD-1, a protein on immune system cells (called T cells), that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against melanoma cells. This can often shrink tumours and help people live longer.  Learn more about immunotherapies.

Article: Considerations for Adjuvant Therapy

If you or a loved one is considering adjuvant treatments here are some questions to consider.

Adjuvant Therapy Update

The latest informaiton on adjuvant therapies, presented live in Hamilton by Dr. Elaine McWhirter MD, MSc., FRCPC, Medical Oncologist, Juravinski Cancer Centre

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