Neoadjuvant immunotherapy with combined ipilimumab and nivolumab in patients with melanoma with primary or in transit disease.

Autor: Weber, J., Glutsch, V., Geissinger, E., Haug, L., Lock, J.F., Schneider, F., Kneitz, H., Goebeler, M., Schilling, B., Gesierich, A.
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Zdroj: British Journal of Dermatology; Sep2020, Vol. 183 Issue 3, p559-563, 5p
Abstrakt: Summary: The introduction of new therapeutic agents has revolutionized the treatment of metastatic melanoma. The approval of adjuvant anti‐programmed death‐1 monotherapy with nivolumab or pembrolizumab, and dabrafenib plus trametinib has recently set a new landmark in the treatment of stage III melanoma. Now, clinical trials have shown that immune checkpoint blockade can be performed in a neoadjuvant setting, an approach established as a standard therapeutic approach for other tumour entities such as breast cancer. Recent studies suggest that a pathological response achieved by neoadjuvant immunotherapy is associated with long‐term tumour control and that short neoadjuvant application of checkpoint inhibitors may be superior to adjuvant therapy. Most recently, neoadjuvant ipilimumab plus nivolumab in stage III melanoma was reported. With two courses of dose‐optimized ipilimumab (1 mg kg−1) combined with nivolumab (3 mg kg−1), pathological responses were observed in 77% of patients, while only 20% of patients experienced grade 3 or 4 adverse events. However, the neoadjuvant trials employing combined immune checkpoint blockade conducted so far have excluded patients with in transit metastases, a common finding in stage III melanoma. Here we report four patients with in transit metastases or an advanced primary tumour who have been treated with neoadjuvant ipilimumab plus nivolumab according to the OpACIN‐neo trial scheme (arm B). All patients achieved radiological disease control and a pathological response. None of the patients has relapsed so far. Linked Comment: Blankenstein and van Akkooi. Br J Dermatol 2020; 183:421–422. What's already known about this topic? Neoadjuvant immunotherapy is used in resectable stage III melanoma with lymph node involvement.Neoadjuvant ipilimumab plus nivolumab is associated with a high pathological complete response (pCR) rate.Pathological response data can be used as a surrogate outcome marker, as pCR and relapse‐free survival appear to correlate.Patients with melanoma with in transit metastases were excluded from prospective clinical trials employing neoadjuvant ipilimumab plus nivolumab. What does this study add? Neoadjuvant immunotherapy was performed in three patients with lymph node and satellite or in transit metastases, and in one patient with an advanced primary and lymph node metastases.All patients achieved a radiological objective response and a pathological response (partial or complete) in all metastatic sites and in the advanced primary.To date, none of the patients has relapsed. Linked Comment: Blankenstein and van Akkooi. Br J Dermatol 2020; 183:421–422. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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