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The Role of Neoadjuvant Therapy in Melanoma

  • Melanoma (RJ Sullivan, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Neoadjuvant therapy in melanoma is an area of active investigation with numerous completed and ongoing trials studying a variety of therapeutic interventions utilizing diverse designs. Here, we review completed and ongoing neoadjuvant trials in melanoma, discuss endpoint assessment, and highlight biomarker development in this context.

Recent Findings

High-risk resectable melanoma with clinically detectable lymph node (LN) with or without in-transit and/or satellite metastases represent ~ 20% of melanoma patients and have a high risk of relapse despite definitive surgery. Adjuvant therapy with anti-PD-1 immunotherapy or BRAF/MEK-targeted therapy has improved relapse-free survival (RFS) and overall survival (OS) in large phase III trials and is approved for this indication. However, despite surgery and adjuvant therapy, many patients relapse and/or experience treatment-related toxicity, underscoring the need to identify and understand mechanisms of response and resistance. In melanoma, neoadjuvant therapy is an active area of research with numerous completed and ongoing trials utilizing FDA-approved and novel agents with intriguing results.

Summary

Neoadjuvant therapy for regionally metastatic disease is an established standard in multiple cancers, where it has been shown to improve operability, facilitate biomarker development, and even is a registrational endpoint for drug development in breast cancer. Recently, a spate of neoadjuvant studies in melanoma has looked at a swathe of agents with promising clinical and biomarker results. Coordinated efforts are underway to translate these findings to earlier stage disease while prioritizing the evaluation of new strategies in unresectable disease.

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Funding

This work was funded in part by an award (712463) from Harry J. Lloyd Charitable Trust (DD).

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Authors and Affiliations

  1. University of Pittsburgh and Department of Medicine, UPMC Cancer Pavilion, 5150 Centre Avenue, Room 463, Pittsburgh, PA, 15232, USA

    Zahra R. Kelly

  2. UPMC Hillman Cancer Center, 5115 Centre Ave. 3rd Floor, Pittsburgh, PA, 15232, USA

    Vikram C. Gorantla

  3. University of Pittsburgh and Department of Medicine, Hillman Cancer Center Research Pavilion, 5115 Centre Avenue, Suite 1.32d, Pittsburgh, PA, 15232, USA

    Diwakar Davar

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  1. Zahra R. Kelly
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Zahra Rahman Kelly declares that she has no conflict of interest.

Vikram C. Gorantla declares that he has no conflict of interest.

Diwakar Davar has received research funding from Merck, Bristol-Myers Squibb, Checkmate Pharmaceuticals, and Tesaro.

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Kelly, Z.R., Gorantla, V.C. & Davar, D. The Role of Neoadjuvant Therapy in Melanoma. Curr Oncol Rep 22, 80 (2020). https://doi.org/10.1007/s11912-020-00944-5

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