Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)?
Adjuvant (ADJ) systemic therapy has transformed melanoma treatment during the past decade. There are, however, still important unanswered questions that lead to debates on the utility and place of ADJ therapy for melanoma. When ADJ trials are reported, they present a hazard ratio with a significant...
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| Language: | English |
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Elsevier
2024-12-01
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| Series: | EJC Skin Cancer |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772611824000053 |
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| author | Alexander C.J. van Akkooi Mario Mandala Paul Nathan Andrew Haydon Michael Postow Piotr Rutkowski |
| author_facet | Alexander C.J. van Akkooi Mario Mandala Paul Nathan Andrew Haydon Michael Postow Piotr Rutkowski |
| author_sort | Alexander C.J. van Akkooi |
| collection | DOAJ |
| description | Adjuvant (ADJ) systemic therapy has transformed melanoma treatment during the past decade. There are, however, still important unanswered questions that lead to debates on the utility and place of ADJ therapy for melanoma. When ADJ trials are reported, they present a hazard ratio with a significant P-value. This illustrates the relative benefit of the ADJ therapy, but do not give insight into the absolute benefit for an individual patient. Number needed to treat (NNT) expresses the number of patients required to receive an intervention in order to prevent one event of interest. It is measured by taking the reciprocal of absolute risk reduction. The smaller is the NNT, the greater the effectiveness of the intervention in the study population. NNT is not static, it can change over time, but will not improve until infinity, it will plateau at some point. NNT needs to be balanced with the number needed to harm (NNH) caused by an ADJ therapy, that, by definition, is overtreatment for patient populations. Other aspects that we, as society, must consider regarding ADJ therapies is if there is only a benefit in preventing recurrences or if this translates into an overall survival benefit. On the other hand, living without stage IV disease is of obvious benefit to the quality of life of patients, as well as the costs of treatment are more severe once they have progressed to stage IV disease. Conclusion: 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. |
| format | Article |
| id | doaj-art-420bba202ec2421aaaf7ece1ccde632b |
| institution | OA Journals |
| issn | 2772-6118 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJC Skin Cancer |
| spelling | doaj-art-420bba202ec2421aaaf7ece1ccde632b2025-08-20T02:38:42ZengElsevierEJC Skin Cancer2772-61182024-12-01210002110.1016/j.ejcskn.2024.100021Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)?Alexander C.J. van Akkooi0Mario Mandala1Paul Nathan2Andrew Haydon3Michael Postow4Piotr Rutkowski5Melanoma Institute Australia, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Correspondence to: Melanoma Institute Australia, PO Box 1479, Crows Nest, NSW 1585, Australia.Department of Medical Oncology, University of Perugia, ItalyMount Vernon Cancer Centre, Northwood and UCLH, London, United KingdomAlfred Hospital, Melbourne, VIC, AustraliaMemorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York City, NY, USAMaria Sklodowska-Curie National Research Institute of Oncology, Warsaw, PolandAdjuvant (ADJ) systemic therapy has transformed melanoma treatment during the past decade. There are, however, still important unanswered questions that lead to debates on the utility and place of ADJ therapy for melanoma. When ADJ trials are reported, they present a hazard ratio with a significant P-value. This illustrates the relative benefit of the ADJ therapy, but do not give insight into the absolute benefit for an individual patient. Number needed to treat (NNT) expresses the number of patients required to receive an intervention in order to prevent one event of interest. It is measured by taking the reciprocal of absolute risk reduction. The smaller is the NNT, the greater the effectiveness of the intervention in the study population. NNT is not static, it can change over time, but will not improve until infinity, it will plateau at some point. NNT needs to be balanced with the number needed to harm (NNH) caused by an ADJ therapy, that, by definition, is overtreatment for patient populations. Other aspects that we, as society, must consider regarding ADJ therapies is if there is only a benefit in preventing recurrences or if this translates into an overall survival benefit. On the other hand, living without stage IV disease is of obvious benefit to the quality of life of patients, as well as the costs of treatment are more severe once they have progressed to stage IV disease. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S2772611824000053MelanomaAdjuvantImmunotherapyBRAFTargeted therapyNumber needed to treat |
| spellingShingle | Alexander C.J. van Akkooi Mario Mandala Paul Nathan Andrew Haydon Michael Postow Piotr Rutkowski Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)? EJC Skin Cancer Melanoma Adjuvant Immunotherapy BRAF Targeted therapy Number needed to treat |
| title | Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)? |
| title_full | Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)? |
| title_fullStr | Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)? |
| title_full_unstemmed | Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)? |
| title_short | Adjuvant systemic therapy in melanoma: Relative versus absolute benefit; the number needed to treat (NNT) versus the number needed to harm (NNH)? |
| title_sort | adjuvant systemic therapy in melanoma relative versus absolute benefit the number needed to treat nnt versus the number needed to harm nnh |
| topic | Melanoma Adjuvant Immunotherapy BRAF Targeted therapy Number needed to treat |
| url | http://www.sciencedirect.com/science/article/pii/S2772611824000053 |
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