{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:55:01Z","timestamp":1791431701064,"version":"4.3.3"},"reference-count":25,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2026,9,18]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Adjuvant systemic therapy improves recurrence-free survival in resected high-risk melanoma, but elderly patients remain markedly under-represented in clinical trials; their competing risk of death from other causes needs to be considered. Consequently, the clinical benefit of adjuvant therapy in older populations remains uncertain. We conducted an international real-world study to evaluate survival outcomes of patients aged \u226575 years with resected stage III-IV melanoma managed with adjuvant systemic therapy or observation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter retrospective cohort study, patients aged \u226575 years with completely resected stage III-IV cutaneous melanoma were identified across 14 international melanoma centers. Patients received either standard adjuvant systemic therapy (anti-programmed cell death protein 1 immunotherapy or BRAF\/MEK-targeted therapy) or observation. The primary endpoint were melanoma-specific survival (MSS) and overall survival (OS). Secondary endpoints included recurrence-free survival (RFS). Survival outcomes were estimated using Kaplan-Meier methods and evaluated with multivariable Cox regression models adjusted for age, stage, sex, and mutation status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 580 patients were included (median age 79 years; range, 75\u201399), of whom 222 (38%) received adjuvant therapy and 358 (62%) underwent observation. Adjuvant therapy was associated with significantly improved MSS, with 5-year MSS of 74% compared with 60% in the observation group (adjusted HR 0.58; 95%\u2009CI 0.40 to 0.85; p=0.005), as well as OS (adjusted HR 0.66, 95%\u2009CI 0.51 to 0.87; p=0.002). Adjuvant therapy was also associated with improved RFS (HR 0.57, 95%\u2009CI 0.45 to 0.72; p&lt;0.0001). Among patients managed with observation, disease recurrence occurred in 69%, yet only 47% of those patients received systemic therapy as first-line management of recurrence. Notably, among observation patients who remained recurrence-free or received systemic therapy after recurrence, MSS was comparable to that observed in adjuvant-treated patients (HR 0.83; 95%\u2009CI 0.55 to 1.25).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large international real-world cohort of elderly patients with resected melanoma, adjuvant therapy was associated with clinically meaningful improvements in MSS, OS and RFS. Although immunotherapy retained efficacy when administered at recurrence, many elderly patients did not receive systemic therapy as first-line management of recurrence. Adjuvant therapy may therefore represent an important strategy to ensure timely access to effective treatment in carefully selected older patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jitc-2026-016060","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:35:11Z","timestamp":1791430511000},"page":"e016060","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of adjuvant therapy on melanoma-specific survival in elderly patients with high-risk resected melanoma: a multicenter international retrospective study"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct06488482","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5336-5578","authenticated-orcid":false,"given":"Andrea","family":"Boutros","sequence":"first","affiliation":[{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy"},{"name":"AOM - IRCCS Ospedale Policlinico San Martino, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"McKeown","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-0355","authenticated-orcid":false,"given":"Roger","family":"Olofsson Bagge","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Ny","sequence":"additional","affiliation":[{"name":"Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden"},{"name":"Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2266-7629","authenticated-orcid":false,"given":"Jan","family":"Mattsson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Spagnolo","sequence":"additional","affiliation":[{"name":"AOM - IRCCS Ospedale Policlinico San Martino, Genoa, Italy"},{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica Teresa","family":"Tanda","sequence":"additional","affiliation":[{"name":"AOM - IRCCS Ospedale Policlinico San Martino, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7921-2820","authenticated-orcid":false,"given":"Ralf","family":"Gutzmer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Skin Cancer Center Minden Johannes-Wesling-Klinikum, Minden\/Ruhr-University Bochum, Minden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyush","family":"Grover","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital, Perth, Western Australia, Australia"},{"name":"Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9417-1596","authenticated-orcid":false,"given":"Lydia","family":"Warburton","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital, Perth, Western Australia, Australia"},{"name":"Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Adnan","family":"Khattak","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas B","family":"Johnson","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle P","family":"Maas","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7784-634X","authenticated-orcid":false,"given":"Hannah","family":"Burnette","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5344-6645","authenticated-orcid":false,"given":"Ryan J","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Mass General Brigham Cancer Institute, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Effiom","sequence":"additional","affiliation":[{"name":"Mass General Brigham Cancer Institute, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleigha R","family":"Lawless","sequence":"additional","affiliation":[{"name":"Mass General Brigham Cancer Institute, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8322-475X","authenticated-orcid":false,"given":"Paolo A","family":"Ascierto","sequence":"additional","affiliation":[{"name":"Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Vanella","sequence":"additional","affiliation":[{"name":"Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Gaudy-Marqueste","sequence":"additional","affiliation":[{"name":"APHM, CHU Timone, Service de Dermatologie et de Canc\u00e9rologie Cutan\u00e9e, Aix-Marseille University, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nausicaa","family":"Malissen","sequence":"additional","affiliation":[{"name":"APHM, CHU Timone, Service de Dermatologie et de Canc\u00e9rologie Cutan\u00e9e, Aix-Marseille University, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Peres","sequence":"additional","affiliation":[{"name":"The Royal Marsden NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anadil","family":"Javaid","sequence":"additional","affiliation":[{"name":"The Royal Marsden NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveena","family":"Idaikkadar","sequence":"additional","affiliation":[{"name":"The Royal Marsden NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Lebb\u00e9","sequence":"additional","affiliation":[{"name":"Service de Dermatologie, H\u00f4pital Saint-Louis, APHP, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laetitia","family":"Da Meda","sequence":"additional","affiliation":[{"name":"Service de Dermatologie, H\u00f4pital Saint-Louis, APHP, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Burke","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3540-8906","authenticated-orcid":false,"given":"Ines","family":"Pires da Silva","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Champalimaud Foundation, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C J","family":"van Akkooi","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Melanoma Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7861-4104","authenticated-orcid":false,"given":"Matteo 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