Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice.

Autor:	Rhodin KE; Department of Surgery, Duke University Medical Center, Durham, NC., Gaughan EM; Department of Medicine, UVA, Charlottesville, VA., Raman V; Department of Surgery, Duke University Medical Center, Durham, NC., Salama AK; Department of Medicine, Duke University Medical Center, Durham, NC., Hanks BA; Department of Medicine, Duke University Medical Center, Durham, NC., Shah R; Department of Medicine, Duke University Medical Center, Durham, NC., Tyler DS; Department of Surgery, UTMB, Galveston, TX., Slingluff CL Jr; Department of Surgery, UVA, Charlottesville, VA., Beasley GM; Department of Surgery, Duke University Medical Center, Durham, NC.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Jun 01; Vol. 277 (6), pp. e1306-e1312. Date of Electronic Publication: 2022 Jul 07.
DOI:	10.1097/SLA.0000000000005459
Abstrakt:	Objective: To determine the feasibility and impact of neoadjuvant therapy (NT) in patients who present with advanced melanoma amenable to surgical resection. Summary Background Data: Given current effective systemic therapy for melanoma, the use of NT is being explored in patients with advanced melanoma with disease amenable to surgical resection. Methods: Prospective data from 3 institutions was obtained in patients with clinically evident Stage III/IV melanoma who underwent NT. The primary objective was to compare recurrence-free survival between patients who had pathologic complete response (pCR) to those with persistent disease. Results: NT was offered to 45 patients, with 43 patients initiating various NT regimens including PD-1 antagonist (PD-1) therapy (N = 16), PD-1 plus ipilimumab (N = 10), BRAF/MEK inhibitor therapy (N = 14), a combination of those three (N = 1), and talimogene laherparepvec (TVEC) (N = 2). Thirty-two (74.1%) patients underwent surgery whereas 11 patients did not undergo surgery for these reasons: clinical CR (N = 7), progressive disease not amenable to resection (N = 3), and ongoing therapy (N = 1). 12 of 32 patients (37.5%) had pCR with these therapies: PD-1 (N = 4), PD-1 plus ipilimumab (N = 2), BRAF/MEK (N = 4), combination (N = 1), and TVEC (N = 1). At median follow-up of 16.4 months there was only 1 recurrence in the pCR group and patients with a pCR had significantly improved recurrence-free survival compared to patients without pCR (p = 0.004). Conclusions: Despite variability in NT regimens across institutions, NT for melanoma is feasible and associated with improved prognosis in patients who achieve a pCR. Maximizing rates of pCR could improve prognosis for patients with advanced melanoma. Competing Interests: The authors report no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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