Response-Based Immunotherapy in Melanoma: A New Paradigm

Historically, the standard of care for melanoma has been surgical resection followed by consideration of adjuvant therapy based on clinical staging, however, there is mounting evidence for a neoadjuvant approach. Administering immunotherapy prior to surgery ensures the maximal antigen stimulus and thus a more robust anti-tumor response. A neoadjuvant approach to therapy also allows for an early readout to assess treatment efficacy, as assessment of pathologic treatment response after neoadjuvant immunotherapy serves as an important prognostic biomarker. Tailoring future treatments based on this metric may both reduce intensity of treatment in patients with a pathologic complete response and to alter or escalate treatment in non-responders. Herein, we review the current evidence for a response-based treatment paradigm for melanoma.