Would you offer adjuvant immunotherapy in an elderly patient with stage IIB desmoplastic melanoma post resection with underlying autoimmune disease?

As discussed with our desmoplastic melanoma expert at The Ohio State University, Kari L. Kendra, MD -

"Because some patients are potentially "cured" with surgical resection alone and this patient has an autoimmune disease, would not treat in the adjuvant setting.

If there is local recurrence, would ...

Patients with autoimmune disease on active immunosuppression are usually excluded from all clinical trials. Even the percentage of patients with autoimmune disease who do not require immunosuppression is much less in clinical trials to draw any significant conclusions.

Hence, to answer this question...

In case patients like this with autoimmune disorders need to be considered for immunotherapy in the future, our site (Ohio State University Comprehensive Cancer Center) has an ongoing NCI-sponsored study under our UM1 grant called "AIM-NIVO" (nivolumab in autoimmune disease).

The AIM-NIVO study is ...

I would not offer adjuvant therapy, but carefully monitor the patient. If disease recur, then I would treat with neoadjuvant immunotherapy in first line prior to other mechanical removal of the recurrent tumor.