What is changing in the adjuvant treatment of melanoma?

Until recently, interferon (IFN)-? was the only drug approved as adjuvant therapy for patients with melanoma at high-risk of recurrence after surgical resection. However, its use remains contentious, with questions over patient selection and optimal treatment regimen as well as concerns over toxicity. The advent of checkpoint inhibitors has revolutionized the treatment of advanced melanoma and their potential use as adjuvant therapy is now a research focus, with ipilimumab approved in the US for adjuvant treatment of melanoma in 2015. Recently reported studies have suggested that adjuvant nivolumab monotherapy is more effective and less toxic than ipilimumab while dabrafenib plus trametinib appears to be superior to BRAF inhibitor monotherapy with vemurafenib, although vemurafenib may have a role in stage IIC disease. Based on these new results, IFN-? can no longer be considered the optimal adjuvant treatment choice in melanoma. Other ongoing studies should provide further data on the role of adjuvant immune- and targeted therapy.