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MSLT-I—response of clinical trial investigators

Nature Reviews Clinical Oncology volume 11, page 680 (2014)Cite this article

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Three recent News & Views articles that were published back-to-back in the May 2014 issue of this journal1,2,3 commented on the final analysis of the first Multicenter Selective Lymphadenectomy Trial (MSLT-I).4 The authors of these articles recognized the size and quality of the trial and were unstinting in their praise of the late Donald Morton, who, with his colleagues, developed sentinel-lymph-node biopsy (SLNB) technique and led the trial from conception to completion. All the articles acknowledged the staging power of SLNB; the MSLT-I confirmed numerous prior reports demonstrating the pathological status of the sentinel node as the most important prognosticator for patients with intermediate-thickness melanomas.4,5

However, we strongly disagree with the commentary by Yang et al. (Why is sentinel lymph node biopsy 'standard of care' for melanoma? Nat. Rev. Clin. Oncol. 11, 245–246; 2014)1 who state that knowledge of nodal tumour status is not of critical value to patients with newly diagnosed melanoma. Such information enables patients to be considered for timely application of additional therapies, including completion lymph-node dissection and IFN-α-2b treatment. The limited clinical benefit of current 'standard' therapies does not devalue accurate staging. Rather, the toxicity and modest benefits of current adjuvant therapy make accurate staging and prognostic assessment more critical, not less. Furthermore, data from the influential EORTC study demonstrate that, in patients with stage III melanomas, only those with microscopic involvement at the time of SLNB derive benefit from adjuvant therapy with IFN.6 Staging information is also required for enrolment in clinical trials of new treatments, but the suggestion that SLNB only be performed in the setting of an adjuvant therapy trial is impractical. Because only approximately 20% of patients with intermediate-risk melanomas have nodal metastases, adjuvant therapy trials would need to enrol five times the number of patients that is required currently, and could only accrue at trial centres. This factor would make completion of the trials virtually impossible.

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Acknowledgements

The authors acknowledge grant support from the National Cancer Institute (grant CA29605).

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Authors and Affiliations

  1. Department of Surgical Oncology, The John Wayne Cancer Institute, Saint John's Health Center, 2200 Santa Monica Boulevard, Santa Monica, 90404, CA, USA

    Mark B. Faries

  2. Laboratory Medicine and Surgery, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, 90095, CA, USA

    Alistair J. Cochran

  3. Melanoma Institute Australia, 40 Rocklands Road, North Sydney, 2060, NSW, Australia

    John F. Thompson

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  1. Mark B. Faries
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Correspondence to Mark B. Faries.

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Faries, M., Cochran, A. & Thompson, J. MSLT-I—response of clinical trial investigators. Nat Rev Clin Oncol 11, 680 (2014). https://doi.org/10.1038/nrclinonc.2014.65-c1

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