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Standard neoadjuvant immunotherapy in patients with resectable stage III Melanoma - The early Australian experience

Francis Proulx-Rocray1, Rebecca Symons2, Yang Wang3

  • 1Melanoma Institute Australia, Sydney, Australia; Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.

European Journal of Cancer (Oxford, England : 1990)
|June 10, 2026
PubMed
Abstract

Insights

Neoadjuvant immune checkpoint inhibitor (ICI) therapy is effective for stage III melanoma, even in real-world settings with in-transit metastases. Adjuvant ICI is recommended after major pathological response to anti-PD-1 monotherapy.

Area of Science:

  • Oncology
  • Immunotherapy
  • Melanoma Research

Background:

  • Neoadjuvant immune checkpoint inhibitor (ICI) therapy shows promise for stage III melanoma.
  • Real-world data are limited, particularly for patient subgroups not included in clinical trials.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of neoadjuvant ICI in a real-world cohort of stage IIIB-D melanoma patients.
  • To compare outcomes between different ICI regimens and assess the impact of adjuvant therapy.

Main Methods:

  • Retrospective review of 268 patients with resectable stage IIIB-D melanoma treated with neoadjuvant ICI outside clinical trials.
  • Analysis of baseline characteristics, treatment details, response rates (radiological and pathological), event-free survival (EFS), and recurrence-free survival (RFS).

Main Results:

  • Combination anti-PD-1 + anti-CTLA-4 therapy was associated with higher 12-month EFS compared to anti-PD-1 monotherapy (85.6% vs 75.6%).
  • Patients achieving major pathological response (MPR) with anti-PD-1 monotherapy had lower 12-month RFS if adjuvant ICI was omitted (80.4% vs 100%).
  • In-transit metastases (ITM)-only patients showed similar EFS to lymph node (LN)-only patients.

Conclusions:

  • Neoadjuvant ICI is a feasible treatment option in real-world practice for stage III melanoma, including those with ITM-only disease.
  • Adjuvant ICI following MPR to anti-PD-1 monotherapy improves outcomes compared to omitting it.
Keywords:
AdjuvantImmune checkpoint inhibitorsImmunotherapyIn-transit metastasesMelanomaNeoadjuvantNonoperative managementReal-world

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