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Single-Dose Neoadjuvant Pembrolizumab in Resectable Metastatic Melanoma
Neha Shafique1, Mohammad Saad Farooq2, Valentina Mattfeld3
1Division of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Annals of Surgical Oncology
|September 12, 2025
Summary
A single dose of neoadjuvant pembrolizumab (anti-PD-1) is safe for oligometastatic melanoma patients, showing early response and good survival, though late recurrences require monitoring.
Area of Science:
- Oncology
- Immunotherapy
- Melanoma Research
Background:
- Neoadjuvant immune checkpoint blockade shows promise for resectable oligometastatic melanoma.
- Optimal neoadjuvant anti-PD-1 agent and dosing remain under investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of a single neoadjuvant dose of pembrolizumab in PD-1 naive patients with resectable oligometastatic melanoma.
Main Methods:
- Retrospective case series of 51 PD-1 naive patients receiving one dose of pembrolizumab (200 mg IV) before surgery.
- Outcomes assessed included surgical complications, pathologic response, recurrence patterns, and 5-year survival.
Main Results:
- No grade 3/4 immune-related adverse events or surgical delays occurred.
- 19.6% achieved major pathologic response (MPR); 100% 5-year overall survival in MPR group.
- 45.1% experienced recurrence, with MPR patients having late, salvageable recurrences.
Conclusions:
- Single-dose neoadjuvant pembrolizumab is safe and feasible, offering early pathologic response assessment.
- Late recurrences in MPR patients necessitate continued follow-up.
- Biomarker research is crucial to identify optimal candidates for neoadjuvant anti-PD-1 therapy.
