Stage 3a Not on Immunutherapy

Posted By
John Paul
4/10/2019 7:53pm
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Replies: 12

Need to ask this question to my Onc next week.  I was told by someone in our Melanoma community that I was one of very few folks they knew diagnosed as Stage 3 not on immunotherapy.  I was diagnosed with a 1.8 primary and a single positive SLN in my neck in early 2018 but my LN completion surgery was clear.  By the Grace of God my scans and bloods have been good but now I’m worried I didn’t do all I could do to prevent recurrence.  I know immunotherapy was not offered to me as an option at the time but I would like to know the reasoning now that I am educated.  Thanks to all as I always go through a little anxiety before these 3 month checkups. 

Here is a pretty good discussion last June on the topic of who to treat when stage 3. https://www.onclive.com/peer-exchange/advanced-melanoma-paradigms/adjuva...

Thank you

Anonymous - (4/11/2019 - 4:16am)

I was diagnosed 3a in January 2107, 1.7mm primary. My options at the time were HDI or surveillance. I elected the latter. I did go back to oncology in autumn 2018 and asked again about treatment options and I was told that since I do not currently present disease there is no evidence that treatment would be beneficial. I was also told that I was just diagnosed that I would be offered immunotherapy options. 

My situation almost identical although it just wasn’t offered as an option.  Thanks it really helps me have a conversation going forward 

Anonymous - (4/11/2019 - 8:18am)

Here is another article you might want to check out by a doctor from Mayo clinic.  https://melanomainternational.org/2018/12/newly-approved-therapies-stage...

Anonymous - (4/11/2019 - 9:22am)

I was 3A too and told this treatment is really only a good idea if you are very risky, deep melanoma high mitotic rate etc.  Get closely checked and you hopefully will be fine as I am now a year later.

You might want to read the trial data from Merck and Bristol myer squibb reported in New England Journal of Medicine. Pembro trial included 3a,b and c patients while BMS trial had 3b, 3c and stage 4 patients based on the old staging system, so I am not sure that it is fair to say that only risky deep melanoma patients with a high mitotic rate is supported by the data in the trialls.https://www.nejm.org/doi/full/10.1056/NEJMoa1709030                               https://www.nejm.org/doi/full/10.1056/NEJMoa1802357

Here is update of checkmate 238 nivo vs  ipi adjuvant trial at 24 months recurrence free survival data!!!https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.9502

Very much appreciated 

Very much appreciated 

John, hopefully this will add a little solace to your situation...I was diagnosed stage 3A , almost 5 years ago(will be 5 in July) primary was 2mm, had .9mm micro met in one lymph node . To date I’ve been fortunate enough to just watch and wait with lymph node ultrasounds. Had a suspicious one pop up last summer and was biopsied to just turn out to be benign...just wanted you to know there’s some of us out there fortunate enough at stage 3A to make it years without reaccurence ...best of luck with your health 

Craig