The following is a summary of “Neoadjuvant Checkpoint Immunotherapy and Melanoma: The Time Is Now,” published in the June 2023 issue of Oncology by Long, et al.

The role of neoadjuvant therapy in oncology is undergoing a significant transformation. Previously utilized to minimize surgical complications, neoadjuvant therapy has become a life-saving treatment with curative potential, particularly for melanoma. Advancements in immunostimulatory anticancer agents have played a pivotal role in this shift. Over the past decade, the field of melanoma has witnessed remarkable improvements in survival outcomes, initially with checkpoint immunotherapies and BRAF-targeted therapies in advanced cases, which were subsequently adopted as adjuvant therapies for the high-risk resectable disease.

Despite substantial reductions in postsurgical recurrence, high-risk resectable melanoma remains a potentially fatal condition with profound consequences. Preclinical models and early-phase clinical trials have provided compelling evidence for the greater efficacy of neoadjuvant administration of checkpoint inhibitors compared to the adjuvant setting. Feasibility studies have shown impressive pathologic response rates to neoadjuvant immunotherapy, leading to recurrence-free survival rates exceeding 90%.

Notably, the randomized phase II SWOG S1801 trial recently reported a 42% reduction in the risk of 2-year event-free survival with neoadjuvant pembrolizumab compared to adjuvant treatment in resectable stage IIIB-D/IV melanoma (72% vs. 49%; hazard ratio 0.58; P = 0.004). This trial established neoadjuvant single-agent immunotherapy as a new standard of care. Ongoing research includes the NADINA trial, a randomized phase III trial investigating neoadjuvant immunotherapy in resectable stage IIIB-D melanoma, and feasibility studies in high-risk stage II disease.

With numerous clinical, quality-of-life, and economic benefits, neoadjuvant immunotherapy can redefine the management of resectable tumors. It represents a significant advancement in the field and offers new hope for patients with melanoma and potentially other cancers as well.

Source: ascopubs.org/doi/full/10.1200/JCO.22.02575