Adjuvant Therapy in Stage IIIA Melanoma: Cost vs Benefit of Gene Profiling Interview with:

Dr. Bartlett

Edmund K Bartlett, M.D.
Department of Surgery/Division of Surgical Oncology
Memorial Sloan Kettering Cancer Center
New York, New York What is the background for this study?

Response: Indications for adjuvant therapy for resected, high-risk melanoma is a controversial and rapidly-evolving topic in melanoma treatment. Immunotherapy treatments targeting PD-1 have significantly improved survival in advanced-stage disease, but the magnitude of survival benefit in stage III disease–particularly stage IIIA–remains unclear. Recently, 31-GEP (a gene expression profiling assay) has been studied as a risk-stratifying tool to identify patients who are at higher risk for systemic recurrence. Ideally such a tool could identify patients most likely to benefit from immunotherapy treatment in the adjuvant setting (when all visible disease has been removed). What are the main findings?

Response: In this study, we use previously-published data on the sensitivity and specificity of 31-GEP to determine the incremental benefit that this risk-stratifying tool adds toward decision-making for adjuvant therapy in stage IIIA melanoma. Based upon our modeling, the cost-to-benefit ratio for adjuvant therapy in this setting is quite high, even after incorporating 31-GEP as a risk-stratifying tool. What should readers take away from your report?

Response: For patients with resected stage IIIA melanoma, it is unclear whether adjuvant systemic therapy significantly improves survival compared to a watch-and-wait approach in which anti-PD1 is administered only upon disease recurrence. Because of this, a policy of treating everyone in the adjuvant setting in order to prevent a small proportion from recurring is extremely costly. Treating only patients who are identified as high-risk based upon the 31-GEP classification only marginally improved this cost-benefit ratio. What recommendations do you have for future research as a result of this work?

Response: To date, there is very little data on the value (or “utility”) that patients place on different disease states in melanoma. How do patients value the trade-off between the up-front toxicity and cost of adjuvant therapy versus the reduced risk of recurrence? Only by determining these relative value weights can we begin to establish which treatment strategies are truly most effective (and cost-effective) in a global sense: incorporating not just length of survival, but quality of survival.

No disclosures


Yinin Hu, Andrew Briggs, Michael A. Marchetti, Charlotte E. Ariyan, Daniel G. Coit, Edmund K. Bartlett,
Cost-Benefit Implication of Gene Expression Profiling and Adjuvant Therapy in Stage IIIA Melanoma,
Journal of the American College of Surgeons,

2020,,ISSN 1072-7515,



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Last Updated on September 3, 2020 by Marie Benz MD FAAD