{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:19:55Z","timestamp":1783113595867,"version":"3.54.6"},"reference-count":13,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2022,6,21]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:p>Until recently, most patients with sentinel lymph node-positive (SLN+) melanoma underwent a completion lymph node dissection (CLND), as mandated in published trials of adjuvant systemic therapies. Following multicenter selective lymphadenectomy trial-II, most patients with SLN+ melanoma\u2009no longer undergo a CLND prior to adjuvant systemic therapy. A retrospective analysis of clinical outcomes in SLN+ melanoma patients treated with adjuvant systemic therapy after July 2017 was performed in 21 international cancer centers. Of 462 patients who received systemic adjuvant therapy, 326 patients received adjuvant anti-PD-1 without prior immediate (IM) CLND, while 60 underwent IM CLND. With median follow-up of 21 months, 24-month relapse-free survival (RFS) was 67% (95% CI 62% to 73%) in the 326 patients. When the patient subgroups who would have been eligible for the two adjuvant anti-PD-1 clinical trials mandating IM CLND were analyzed separately, 24-month RFS rates were 64%, very similar to the RFS rates from those studies. Of these no-CLND patients, those with SLN tumor deposit &gt;1\u2009mm, stage IIIC\/D and ulcerated primary had worse RFS. Of the patients who relapsed on adjuvant anti-PD-1, those without IM CLND had a higher rate of relapse in the regional nodal basin than those with IM CLND (46% vs 11%). Therefore, 55% of patients who relapsed without prior CLND underwent surgery including therapeutic lymph node dissection (TLND), with 30% relapsing a second time; there was no difference in subsequent relapse between patients who received observation vs secondary adjuvant therapy. Despite the increased frequency of nodal relapses, adjuvant anti-PD-1 therapy may be as effective in SLN+ pts\u2009who forego IM CLND and salvage surgery with TLND at relapse may be a viable option for these patients.<\/jats:p>","DOI":"10.1136\/jitc-2021-004417","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T11:11:30Z","timestamp":1661339490000},"page":"e004417","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Outcomes with adjuvant anti-PD-1 therapy in patients with sentinel lymph node-positive melanoma without completion lymph node dissection"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2307-7030","authenticated-orcid":false,"given":"Zeynep","family":"Eroglu","sequence":"first","affiliation":[{"name":"Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA"},{"name":"University of South Florida, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy K","family":"Broman","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA"},{"name":"University of South Florida, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2816-2496","authenticated-orcid":false,"given":"John F","family":"Thompson","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, North Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Nijhuis","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, North Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina J","family":"Hieken","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Kottschade","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M","family":"Farma","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Hotz","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremiah","family":"Deneve","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, 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Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Stahlie","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Han","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Vetto","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6387-9030","authenticated-orcid":false,"given":"Georgia","family":"Beasley","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University, Durham, North Carolina, 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Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey","family":"Chai","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyri","family":"Teras","sequence":"additional","affiliation":[{"name":"North Estonia Medical Centre Foundation, Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, 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