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Neoadjuvant Therapy for Melanoma

Until now, melanoma treatment has involved chemotherapy after surgery to remove tumors. It involves the use of adjuvant checkpoint inhibitors and targeted therapy. Although treatments continue to improve, nearly half of all patients with advanced disease relapse within 2 years.

What is neoadjuvant therapy?

Neoadjuvant therapy is the treatment before the treatment. The neoadjuvant treatment approach has resulted in improved recurrence-free survival in other types of cancer, including breast cancer. Neoadjuvant therapy is in its early stages for melanoma and involves pretreating the disease using immunotherapy.

That’s the message coming out of the 2019 Society of Surgical Oncology Annual Cancer Symposium.3 The findings suggest that neoadjuvant immunotherapy is effective in some people diagnosed with stage III or oligometastatic stage IV melanoma (disease in three or fewer sites excluding the bone and central nervous system) for whom surgery is the follow-on recommendation.3

What is melanoma?

Melanoma is a skin cancer of the melanocytes, the pigment-producing cells. Exposure to UV radiation from the sun or other environmental causes can be the catalyst for developing melanoma. The leading cause of death from skin cancer, melanoma represents only around 5% of all skin cancer cases.

Current research

The research centers around immune checkpoint inhibitors and targeted therapies prior to the surgical removal of a tumor. These are drugs that block certain proteins and work with the body’s immune system to fight some kinds of cancer by sending T cells to detect and fight the infections and cancer.

There is currently active research in multiple clinical trials aimed at evaluating the effectiveness of immunotherapy prior to surgery. Currently these therapies are in Stage II of the clinical trial process. This means they are being tested to evaluate the effectiveness compared to existing medications or treatments for the same condition. This therapeutic approach does not yet have FDA approval.

Neoadjuvant therapy

Neoadjuvant treatment allows physicians to assess individual responses, including tolerability to therapy earlier in the disease course, allowing for any necessary modifications in surgical or postsurgical treatment plans. An important part of treatment planning is understanding how cancer subtypes respond to targeted therapies that may impede the growth of the cancer.

Additional current research

Several small ongoing studies are looking at single and combination neoadjuvant regimens in advanced stage III and resected stage IV melanoma, cases which are at high risk of recurrence. The preliminary research holds promise. It shows that when treating with chemotherapy before surgery, people are experiencing longer survival and have a clinically meaningful immunologic response. The objective is that this kind of treatment attacks primary tumors and any micrometastatic disease.

Neoadjuvant treatment appears to lead to an increase in both disease-free survival and overall survival. One tool used to evaluate the effectiveness of neoadjuvant treatment is examination of tissue removed during biopsy or surgery to determine if there are any active cancer cells. If none are present, it is considered a pathologic response-the cancer cells have responded to the treatment.2

Immunotherapy is improving lives

Across the medical spectrum, results show that immunotherapy treatments generally are improving overall quality of life and survival. New research reflects an improvement in targeted treatments for people with melanoma. Clinical trials are investigating the safety, tolerability, and effectiveness of several different drugs, alone and in combination, to advance treatment of the deadly disease.2

  1. Zhao, J. Galvez, C., Sosman, J. Neoadjuvant Therapy for Melanoma. Available at: https://www.skincancer.org/publications/the-melanoma-letter/2019-vol-37-no-1/neoadjuvant. Accessed 7.23.19.
  2. Tutt, B. Neoadjuvant Immunotherapy for Melanoma. Available at: https://www.mdanderson.org/publications/oncolog/neoadjuvant-immunotherapy-for-melanoma.h10-1591413.html. Accessed 7.23.19.
  3. Doyle C. Neoadjuvant Immunotherapy Associated With Improved Outcomes in Patients With Locally Advanced Melanoma. Available at: https://www.ascopost.com/issues/may-10-2019/neoadjuvant-immunotherapy-in-locally-advanced-melanoma/. Accessed 7.23.19.

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