Neoadjuvant checkpoint inhibitor immunotherapy for resectable mucosal melanoma

Area of Science:

• Oncology
• Dermatology
• Immunotherapy

Background:

• Mucosal melanoma (MM) is a rare subtype with limited research on neoadjuvant therapies.
• Cutaneous melanoma has shown positive outcomes with neoadjuvant checkpoint inhibition (CPI).
• Current data on CPI for unresectable or metastatic MM shows response rates of 37-43%.

Purpose of the Study:

• To evaluate the safety and efficacy of neoadjuvant CPI in patients with resectable mucosal melanoma.
• To determine the feasibility of using CPI in the preoperative setting for MM.
• To assess event-free survival (EFS), overall survival (OS), objective response rate (ORR), and pathologic response rate (PRR).

Main Methods:

• Retrospective analysis of 36 adult MM patients receiving neoadjuvant anti-PD1 +/- anti-CTLA4 from 2015-2019.
• Collection of clinical data including demographics, disease characteristics, and treatment details.
• Evaluation of outcomes such as EFS, OS, ORR, PRR, and grade ≥3 toxicities.

Main Results:

• Median follow-up was 37.9 months; 3-year EFS rate was 29% and 3-year OS rate was 55%.
• Objective response rate (ORR) was 47% and pathologic response rate (PRR) was 35%.
• Grade 3 toxicities occurred in 39% of patients; EFS and OS were significantly higher for patients with objective and pathologic response.

Conclusions:

• Neoadjuvant CPI is a feasible approach for resectable MM, demonstrating efficacy and an acceptable safety profile.
• This study supports further investigation of neoadjuvant therapy for resectable MM, given the lack of a standard approach.
• Neoadjuvant CPI offers a promising treatment option for patients with resectable mucosal melanoma.