Optimal Adjuvant Therapy Selection for Chinese BRAF V600‐Mutant Stage III Melanoma: A Multicenter Efficacy Comparison of Targeted Agents, Immunotherapy, and Combinatorial Strategies

While adjuvant immunotherapy and BRAF/MEK inhibitors improve the outcomes for BRAF V600‐mutant stage III melanoma, comparisons of long‐term survival and safety of these therapeutic modalities are currently lacking in Chinese patients. We retrospectively analyzed data from patients with resected stage III BRAF V600‐mutant melanoma who received adjuvant therapy between June 2013 and December 2023 across three centers in China. Note that 122 patients were included and categorized into interferon ( n = 25), aPD‐1 ( n = 18), D/T ( n = 62), and BRAFi/aPD‐1 ( n = 17) cohorts. The D/T group demonstrated a significantly longer median RFS compared to the interferon and aPD‐1group (22.7 vs. 11.9 months, p = 0.005; vs. 12.5 months, p < 0.001). Similar results were obtained by restricted‐mean‐survival‐time model. Patients who continued D/T beyond 1 year exhibited significantly improved RFS and DMFS compared to those who discontinued at 1 year duration (NR vs. 22.0 months, p = 0.048; NR vs. 22.5 months, p = 0.026). NOTCH4 and IL7R mutations may serve as prognostic and predictive biomarkers for long‐term survival and targeted‐immunotherapy efficacy, respectively. Adjuvant therapy with D/T may represent the most effective treatment strategy for Chinese patients with stage III melanoma harboring BRAF V600 mutations. A combination of BRAF‐targeted therapy and aPD‐1 immunotherapy provided comparable efficacy and may be an alternative for a specific patient.