Bettina Ryll, Founder of
“Got to kind of love the authors for this ‘living without stage IV disease is of obvious benefit to the quality of life of patients’ – it’s obviously not entirely correct- living without stage IV disease isn’t only benefiting your QUALITY of life, it means you get QUANTITY of it, too- which is kind of the entire point.
It’s nice to read a balanced discussion about the risk/ benefit trade-offs, long overdue after those unselected Stage2 trials. Not sure I agree on the solutions -we’ve been looking for predictive immuno markers for ages now and not very successfully so, we know that micromets are common (the Marsden autopsies?), Melanoma is famous for late recurrences which leaves people with early Melanoma with a Damocles sword hanging over their lives, for some, with considerable psychological impact.
So we’d rather have something like a ‘surveillance marker’- we’ve had a planning meeting for MPNE2024 only last weekend with the MPNEurope community, so it’s fresh :)- if we were able to measure whether the immune system was able to control the disease…we’d treat the moment it was failing and otherwise, let everyone in peace…which would actually address both issues: we only expose those in need to the risk of toxicity. And we reassure anyone else….
And thanks for the Open Access!”
“Adjuvant Systemic Therapy in Melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)?
Freely Available (Feb 6th 2024)
Bold conclusions of the authors: “We must weigh the absolute benefits of adjuvant systemic therapy in melanoma as a number needed to treat (NNT) and have agreement within society of what is an acceptable balance of NNT versus NNH. There is an urgent need to develop a bespoke, personalized panel of biomarkers to better predict prognosis of individual patients and subsequently have a better identification of who actually benefits from adjuvant systemic therapy and thereby reducing the NNT.”
I find this article to be an excellent, well-rounded exploration of the potential benefits and risks of adjuvant therapy for melanoma, addressing both the individual patient level and societal considerations.
My heartfelt congratulations to the authors: Alexander van Akkooi, Mario Mandalà, Paul Nathan, Andrew Haydon, Michael Postow, and Piotr Rutkowski.”