Neoadjuvant immunotherapy in melanoma: From pathologic response to response-adapted management

Area of Science:

• Oncology
• Immunotherapy
• Melanoma Research

Background:

• Neoadjuvant immunotherapy is revolutionizing resectable stage III melanoma management.
• This approach primes the immune system against tumors, offering advantages over adjuvant therapy.
• It is also being investigated for oligometastatic stage IV melanoma.

Purpose of the Study:

• To review the current status of neoadjuvant immunotherapy for resectable stage III melanoma.
• To discuss its investigational role in oligometastatic stage IV disease.
• To explore future directions, including biomarker-driven strategies and novel combinations.

Main Methods:

• Summarizes pivotal randomized trials (e.g., SWOG S1801, NADINA).
• Compares neoadjuvant PD-1-based therapy with adjuvant therapy.
• Evaluates pathologic response as a prognostic marker and potential surrogate endpoint.

Main Results:

• Neoadjuvant PD-1-based therapy significantly improves event-free survival versus adjuvant therapy alone.
• Establishes neoadjuvant immunotherapy as the standard of care for selected stage III melanoma patients.
• Pathologic response is a strong predictor of long-term survival.

Conclusions:

• Neoadjuvant immunotherapy is a new standard for resectable stage III melanoma.
• Pathologic response aids in personalizing treatment and potentially reducing toxicity.
• Further research is needed to validate predictive biomarkers for treatment selection.