Erschienen in:
19.08.2023 | ASO Perspectives
Timing is Everything: Neoadjuvant Versus Adjuvant Immunotherapy in Patients with Resectable Metastatic Melanoma
verfasst von:
Ashley M. Holder, MD, Jennifer A. Wargo, MD, MMSc, Merrick I. Ross, MD
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 12/2023
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Excerpt
Immune checkpoint blockade (ICB)-based immunotherapy (anti-CTLA-4 and anti-PD-1 antibodies) and tyrosine kinase inhibitor-based targeted therapy (BRAF/MEK) have revolutionized the treatment of patients with unresectable stage III or IV melanoma. The resultant improved survival outcomes have provided the rationale to investigate the role of these novel agents in the post-surgical adjuvant setting in patients with resectable high-risk stage III nodal and oligometastatic stage IV disease. The results of three randomized trials demonstrating disease-free survival advantages with the post-resection use of BRAF/MEK combination targeted therapy in stage III patients with BRAF-mutated tumors (Combi-AD
1) and single-agent anti-PD-1 immunotherapy in stage III (CheckMate 238
2 and Keynote-054
3) and stage IV (CheckMate 238
4) patients regardless of BRAF mutational status provide the basis for the current US FDA-approved standards of care. A fourth adjuvant trial, ImmuNED
5, accrued patients exclusively with resected stage IV disease and used a three-arm randomization schema of placebo, single-agent anti-PD-1, or combination checkpoint blockade (anti-PD-1 plus anti-CTLA-4). A recent updated report showed improved survival outcomes with either of the two immunotherapy regimens compared with placebo and best outcome with the standard high-dose combination ICB regimen. …