Yervoy®: A New Option for Patients with Stage III Melanoma after Surgery

Sekwon Jang, MD, is board certified in internal medicine, hematology and medical oncology. He specializes in managing melanoma and other skin cancers. Dr. Jang is the director of Melanoma and Cutaneous Oncology Therapeutics and Research at the Inova Dwight and Martha Schar Cancer Institute. Read Dr. Jang’s profile.

Patients with stage III melanoma (when the cancer has spread to lymph nodes) who had surgery may still have cancer cells remaining in the body, even if all of the cancer seems to have been removed by the surgery. Until recently, interferon treatments were the only approved postsurgical therapy to try and prevent these cells from spreading and growing. However, interferon treatments can cause severe side effects that many patients can’t tolerate. In fact, some patients may need to stop the treatments because of the difficulty of the side effects.

New Option for Patients with Melanoma
On October 28, 2015, the U.S. Food and Drug Administration expanded the approved use of immunotherapy drug, Yervoy® (ipilimumab) as adjuvant therapy for patients with stage III melanoma. The medication lowers the risk that the melanoma will return following surgery. Yervoy was approved in 2011 for patients whose melanoma cannot be completely removed by surgery. It is given as an intravenous infusion once every three weeks for four treatments, using a dosage of three mg per kilogram.

Approximately 20-25 percent of patients with advanced melanoma benefit from Yervoy treatment. Clinical trial has shown that in patients with stage III melanoma, we can cut the chance of recurrence by a quarter (for example, lowering a 40 percent risk of recurrence to 30 percent). The dose used in this trial was 10mg per kilogram given once every three weeks for four treatments, then given every 12 weeks until three years from the first treatment.

We are still waiting for follow-up data from this trial to answer whether the benefit extends to improvement in survival. We are also awaiting the result from another trial (ECOG 1609) to find out whether Yervoy is superior to interferon or not, as well as what is the right dose of Yervoy for stage III melanoma (10mg vs. 3mg).

Yervoy: Proceed with Caution
Yervoy can cause the immune system to attack other parts of the body, which can lead to serious problems in the skin, bowel, liver, hormone glands, eyes or other organs. Deciding whether to use adjuvant Yervoy therapy will be—like any treatment decision—a personal decision between the patient and doctor. We will need to weight the potential benefits and side effects of this treatment to determine if it is right for each patient.