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A Melanoma Patient-Derived Xenograft Model
Published on: May 20, 2019
Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice
Kristen E Rhodin1, Elizabeth M Gaughan2, Vignesh Raman1
1Department of Surgery, Duke University Medical Center, Durham, NC.
Objective:
To determine the feasibility and impact of neoadjuvant therapy (NT) in patients who present with advanced melanoma amenable to surgical resection.
Summary Background Data:
Given current effective systemic therapy for melanoma, the use of NT is being explored in patients with advanced melanoma with disease amenable to surgical resection.
Methods:
Prospective data from 3 institutions was obtained in patients with clinically evident Stage III/IV melanoma who underwent NT. The primary objective was to compare recurrence-free survival between patients who had pathologic complete response (pCR) to those with persistent disease.
Results:
NT was offered to 45 patients, with 43 patients initiating various NT regimens including PD-1 antagonist (PD-1) therapy (N = 16), PD-1 plus ipilimumab (N = 10), BRAF/MEK inhibitor therapy (N = 14), a combination of those three (N = 1), and talimogene laherparepvec (TVEC) (N = 2). Thirty-two (74.1%) patients underwent surgery whereas 11 patients did not undergo surgery for these reasons: clinical CR (N = 7), progressive disease not amenable to resection (N = 3), and ongoing therapy (N = 1). 12 of 32 patients (37.5%) had pCR with these therapies: PD-1 (N = 4), PD-1 plus ipilimumab (N = 2), BRAF/MEK (N = 4), combination (N = 1), and TVEC (N = 1). At median follow-up of 16.4 months there was only 1 recurrence in the pCR group and patients with a pCR had significantly improved recurrence-free survival compared to patients without pCR (p = 0.004).
Conclusions:
Despite variability in NT regimens across institutions, NT for melanoma is feasible and associated with improved prognosis in patients who achieve a pCR. Maximizing rates of pCR could improve prognosis for patients with advanced melanoma.
Insights
Neoadjuvant therapy (NT) for advanced melanoma is feasible and improves outcomes for patients achieving a pathologic complete response (pCR). Maximizing pCR rates can enhance prognosis in advanced melanoma patients.
Area of Science:
- Oncology
- Dermatology
- Surgical Oncology
Background:
- Systemic therapies for melanoma have advanced, prompting exploration of neoadjuvant therapy (NT) for advanced melanoma.
- NT is being investigated in patients with surgically resectable advanced melanoma.
Purpose of the Study:
- To assess the feasibility and impact of neoadjuvant therapy (NT) in advanced melanoma patients.
- To compare recurrence-free survival (RFS) between patients achieving pathologic complete response (pCR) and those with persistent disease after NT.
Main Methods:
- Prospective data from three institutions on patients with Stage III/IV melanoma receiving NT.
- Analysis of RFS based on pCR status following various NT regimens (PD-1 antagonist, PD-1 plus ipilimumab, BRAF/MEK inhibitors, TVEC).
Main Results:
- Of 43 patients initiating NT, 32 underwent surgery. 12 of 32 (37.5%) achieved pCR across different regimens.
- Patients with pCR demonstrated significantly improved RFS compared to those without pCR (p = 0.004).
- Only one recurrence was observed in the pCR group at a median follow-up of 16.4 months.
Conclusions:
- Neoadjuvant therapy for advanced melanoma is feasible, with varied regimens showing efficacy.
- Achieving a pathologic complete response (pCR) after NT is associated with significantly improved recurrence-free survival.
- Increasing pCR rates holds potential for improving the prognosis of patients with advanced melanoma.
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