Neoadjuvant immunotherapy in melanoma: pathological response as a surrogate endpoint?

Area of Science:

• Oncology
• Immunotherapy
• Melanoma Research

Background:

• Pathological complete response (pCR) is a critical prognostic biomarker in various cancers, including breast cancer.
• Its role as a surrogate marker in melanoma, particularly with neoadjuvant therapies, is under increasing investigation.

Purpose of the Study:

• To evaluate the reliability of pathological complete response (pCR) as a surrogate marker for overall survival (OS) in melanoma patients receiving neoadjuvant immunotherapy.
• To compare the predictive value of pCR in melanoma treated with neoadjuvant immunotherapy versus targeted therapy.

Main Methods:

• Systematic review and analysis of recent clinical trials and studies on neoadjuvant therapy for melanoma.
• Comparative analysis of outcomes, including pCR and overall survival (OS), between immunotherapy and targeted therapy regimens.

Main Results:

• Targeted therapies for melanoma show pCR is crucial for long-term success (e.g., Neo-Combi, Neo-Trio).
• Immunotherapy offers durable survival benefits even with partial responses (e.g., OpACIN-neo, SWOG S1801).
• Immunotherapy demonstrates higher pathologic response rates and improved survival outcomes compared to pCR-dependent targeted therapies (e.g., NADINA, INMC analysis).

Conclusions:

• pCR is a validated prognostic biomarker in breast cancer, predicting long-term survival, especially in aggressive subtypes.
• In melanoma, pCR's predictive value differs between targeted treatments and immunotherapies.
• Further melanoma-specific studies are needed to validate pCR as a universal surrogate endpoint for neoadjuvant immunotherapy.