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A Melanoma Patient-Derived Xenograft Model
Published on: May 20, 2019
Neoadjuvant therapy for melanoma: rationale for neoadjuvant therapy and pivotal clinical trials
Russell G Witt1, Derek J Erstad1, Jennifer A Wargo2
1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Abstract:
The treatment of malignant melanoma has drastically changed over the past decade with the advent of immune checkpoint blockade, targeted therapy with BRAF/MEK inhibition, and other novel therapies such as oncolytic virus intralesional therapy. Despite improvements in patient response rates and survival with these new treatments, there exists a large portion of patients with surgically resectable disease that are high risk for relapse. Patients with high-risk resectable melanoma account for up to 20% of newly diagnosed cases. For this high-risk group of patients, neoadjuvant therapy has many purposed advantages over adjuvant therapy, including a more robust immune response due to abundant tumor antigens at treatment initiation, the ability to assess pathologic response to therapy, tumor downstaging leading to increased disease resectability, and a potential decreased need for extensive lymphadenectomies. These findings have been backed by preclinical models and multiple neoadjuvant trials are underway. In this review, we will discuss the trials that have set the foundation for the current treatment standards and discuss the role and rationale for neoadjuvant therapy for high-risk malignant melanomas.
Insights
Neoadjuvant therapy offers advantages for high-risk melanoma patients, potentially improving immune response and surgical outcomes. This approach is being explored in ongoing clinical trials for resectable disease.
Area of Science:
- Oncology
- Immunology
- Dermatology
Background:
- Malignant melanoma treatment has evolved with immunotherapy and targeted therapies.
- A significant subset of patients with resectable melanoma face high relapse risks.
- Neoadjuvant therapy is emerging as a promising strategy for this patient group.
Purpose of the Study:
- To review foundational trials and current standards in neoadjuvant melanoma treatment.
- To discuss the rationale and benefits of neoadjuvant therapy for high-risk melanoma.
- To highlight ongoing clinical trials investigating neoadjuvant approaches.
Main Methods:
- Review of preclinical models and clinical trial data.
- Analysis of neoadjuvant therapy's impact on immune response and pathologic outcomes.
- Discussion of treatment advantages over adjuvant therapy.
Main Results:
- Neoadjuvant therapy may enhance immune response by utilizing abundant tumor antigens.
- Pathologic response assessment and tumor downstaging are key benefits.
- Potential reduction in the need for extensive lymphadenectomies.
Conclusions:
- Neoadjuvant therapy presents a compelling strategy for high-risk resectable melanoma.
- Ongoing trials are crucial for establishing neoadjuvant treatment as a standard of care.
- This approach holds promise for improving outcomes in melanoma management.
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