Five-year survival after introduction of adjuvant treatment in stage III melanoma : A nationwide registry-based study
(2026) In European Journal of Cancer 234.- Abstract
Background In patients with stage III cutaneous melanoma, adjuvant treatments with PD-1 and BRAF+MEK inhibitors were approved based on improved recurrence-free survival. However, as the treatments have significant side effects and costs, the effect on overall survival remains a matter of great importance. Methods Clinical and histopathological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with stage IIIB-D melanoma in 2016–2020. Patients under the age of 75 years, that had a positive sentinel lymph node (SLN) were included. Patients were divided into two cohorts, depending on if the SLN biopsy was performed before or from September 2018 (pre- and post-cohort), based on the timepoint when adjuvant... (More)
Background In patients with stage III cutaneous melanoma, adjuvant treatments with PD-1 and BRAF+MEK inhibitors were approved based on improved recurrence-free survival. However, as the treatments have significant side effects and costs, the effect on overall survival remains a matter of great importance. Methods Clinical and histopathological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with stage IIIB-D melanoma in 2016–2020. Patients under the age of 75 years, that had a positive sentinel lymph node (SLN) were included. Patients were divided into two cohorts, depending on if the SLN biopsy was performed before or from September 2018 (pre- and post-cohort), based on the timepoint when adjuvant treatment was introduced. Patients were followed for survival until the end of 2024. Results The five-year overall survival rates were, 67.3 % (95 % CI 62.0–72.9) in the pre-cohort (n = 287) and 70.1 % (95 % CI 65.3–75.2) in the post-cohort (n = 349), with hazard ratio adjusted for age, sex and tumor stage of 0.96 (95 % CI 0.73–1.27), P= 0.791. In the post-cohort 72.8 % received adjuvant treatment, the majority with PD-1 inhibitors where treatment exposure was highest in those < 60 years (80.2 %), males (78.3 %) and those having thicker primary melanomas (75.4 %). No significant overall or melanoma-specific survival differences were observed when comparing the pre- and the post-cohort in different subgroups. Conclusions In this nationwide, population and registry-based study there was no overall survival benefit observed five years after the introduction of adjuvant treatment for patients with stage III melanoma. These findings encourage a careful assessment of the current recommendation on adjuvant treatment.
(Less)
- author
- Helgadottir, Hildur ; Ny, Lars ; Ullenhag, Gustav J. ; Mikiver, Rasmus ; Isaksson, Karolin LU and Olofsson Bagge, Roger
- organization
- publishing date
- 2026-02-05
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adjuvant treatment, BRAF and MEK inhibitors, Immune checkpoint inhibitors, Melanoma, Overall survival, PD-1 inhibitors
- in
- European Journal of Cancer
- volume
- 234
- article number
- 116201
- publisher
- Elsevier
- external identifiers
-
- pmid:41500895
- scopus:105026701093
- ISSN
- 0959-8049
- DOI
- 10.1016/j.ejca.2025.116201
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2026 The Authors.
- id
- ca4184a8-ff29-4f9d-88db-873717cb71f1
- date added to LUP
- 2026-03-19 15:26:33
- date last changed
- 2026-05-14 22:01:22
@article{ca4184a8-ff29-4f9d-88db-873717cb71f1,
abstract = {{<p>Background In patients with stage III cutaneous melanoma, adjuvant treatments with PD-1 and BRAF+MEK inhibitors were approved based on improved recurrence-free survival. However, as the treatments have significant side effects and costs, the effect on overall survival remains a matter of great importance. Methods Clinical and histopathological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with stage IIIB-D melanoma in 2016–2020. Patients under the age of 75 years, that had a positive sentinel lymph node (SLN) were included. Patients were divided into two cohorts, depending on if the SLN biopsy was performed before or from September 2018 (pre- and post-cohort), based on the timepoint when adjuvant treatment was introduced. Patients were followed for survival until the end of 2024. Results The five-year overall survival rates were, 67.3 % (95 % CI 62.0–72.9) in the pre-cohort (n = 287) and 70.1 % (95 % CI 65.3–75.2) in the post-cohort (n = 349), with hazard ratio adjusted for age, sex and tumor stage of 0.96 (95 % CI 0.73–1.27), P= 0.791. In the post-cohort 72.8 % received adjuvant treatment, the majority with PD-1 inhibitors where treatment exposure was highest in those < 60 years (80.2 %), males (78.3 %) and those having thicker primary melanomas (75.4 %). No significant overall or melanoma-specific survival differences were observed when comparing the pre- and the post-cohort in different subgroups. Conclusions In this nationwide, population and registry-based study there was no overall survival benefit observed five years after the introduction of adjuvant treatment for patients with stage III melanoma. These findings encourage a careful assessment of the current recommendation on adjuvant treatment.</p>}},
author = {{Helgadottir, Hildur and Ny, Lars and Ullenhag, Gustav J. and Mikiver, Rasmus and Isaksson, Karolin and Olofsson Bagge, Roger}},
issn = {{0959-8049}},
keywords = {{Adjuvant treatment; BRAF and MEK inhibitors; Immune checkpoint inhibitors; Melanoma; Overall survival; PD-1 inhibitors}},
language = {{eng}},
month = {{02}},
publisher = {{Elsevier}},
series = {{European Journal of Cancer}},
title = {{Five-year survival after introduction of adjuvant treatment in stage III melanoma : A nationwide registry-based study}},
url = {{http://dx.doi.org/10.1016/j.ejca.2025.116201}},
doi = {{10.1016/j.ejca.2025.116201}},
volume = {{234}},
year = {{2026}},
}