Real-World Outcomes for Patients with Clinically Node-Positive Melanoma Undergoing Neoadjuvant Immunotherapy and...

Area of Science:

• Oncology
• Immunotherapy
• Surgical Oncology

Background:

• Neoadjuvant immunotherapy (nIO) followed by therapeutic lymph node dissection (TLND) is a standard treatment for clinical stage III melanoma.
• Assessing pathologic response (PR) after nIO is crucial for understanding treatment efficacy.

Purpose of the Study:

• To evaluate the association between pathologic response (PR) and survival outcomes in patients with clinical stage III melanoma.
• To compare the impact of different nIO regimens (combination vs. single-agent) on survival after TLND.

Main Methods:

• Retrospective analysis of 121 patients with clinical stage III melanoma treated with nIO and TLND (2016-2024).
• Pathologic response (PR) assessed using established guidelines.
• Disease-free survival (DFS) and overall survival (OS) analyzed in relation to PR and nIO regimen.

Main Results:

• Pathologic complete response (pCR) rates were 64.2% for combination nIO and 53.8% for single-agent anti-PD-1 (P=0.11).
• Patients achieving pCR had significantly better 2-year DFS (94.4%) and OS (98.1%) compared to those with pathologic non-response (pNR) (DFS 57.3%, OS 94.7%).
• Multivariable analysis confirmed PR as a significant predictor of DFS, while the nIO regimen did not show a significant association with survival.

Conclusions:

• Pathologic response (PR) is a strong predictor of survival in melanoma patients undergoing neoadjuvant immunotherapy and therapeutic lymph node dissection.
• Current nIO regimens do not significantly impact survival outcomes; focus should be on response assessment.
• Future research should explore treatment de-escalation based on PR and identify biomarkers for achieving pCR with monotherapy.