- To provide a rational for neoadjuvant immunotherapy in patients with melanoma
- To provide an update on the research efforts with neoadjuvant immunotherapy approaches in patients with melanoma
- To provide a future perspective in terms of neoadjuvant immunotherapy in patients with melanoma
|Title||Duration||Content||CME Points||CME Test|
|Neoadjuvant Immunotherapy in Melanoma – The Pathway Towards Personalised Immunotherapy||46 min.||63 slides||1||Take test|
In this E-Learning module the author explains advantages and potential disadvantages of neoadjuvant immunotherapy in patients with melanoma, highlights the results from relevant clinical trials and features future research goals/directions towards personalised neoadjuvant immunotherapy.
The author underlines a rational that has led to neoadjuvant treatment research efforts. In particular, targeted therapy and immunotherapy have improved overall survival in patients with stage IV melanoma. However, only a subgroup of patients benefits long-term from the current therapies.
The author provides an overview of potential benefits from neoadjuvant treatment as follows: therapy efficacy can be determined within the individual patient for possible additional adjuvant therapy; reduce tumour burden before surgery; utilise pathological response data as surrogate outcome markers for relapse-free and overall survival; easier baseline biomarker identification due to more homogenous patient populations. In the case of T cell checkpoint blockade, neoadjuvant therapy could induce stronger and broader tumour-specific T cell response.
However, patients not responding to neoadjuvant treatment might deteriorate and will not make it to potential curative surgery; immune-related adverse effects might hamper surgery; neoadjuvant therapy might not be better than adjuvant therapies. Neoadjuvant therapies require more patient management, timing scans, day clinic appointments and surgery planning; moreover, there is a relevant clinical problem of elucidating pseudoprogression versus real progression.
The pathological response and survival data with neoadjuvant therapy in melanoma are presented from a pooled analysis from the International Neoadjuvant Melanoma Consortium.The author puts emphasis on neoadjuvant versus adjuvant checkpoint inhibition in macroscopic stage III melanoma. Neoadjuvant anti-PD-1 monotherapy is insufficient; therefore, the author elaborates if toxicity can be reduced, but efficacy preserved by modulating the ipilimumab plus nivolumab neoadjuvant scheme.
The future research goals aiming to confirm the high pathological response rate of ipilimumab plus nivolumab combination scheme and the identification of alternative neoadjuvant combination schemes for biomarker-unfavourable patients are presented by illustrating the OpACIN-neo study results.
The author expresses his firm belief that cancer therapies have a future in personalised immunotherapy.
The author has reported Advisory role: BMS, MSD, Roche, Novartis, GSK, AZ, Pfizer, Lilly, GenMab, Pierre Fabre
Research funding: BMS, Novartis, NanoString
Stockownership: Uniti Cars, Neon Therapeutics, Forty Seven.