Highlights
- •Response to neoadjuvant therapy is concordant in the primary site and nodal melanoma.
- •Neoadjuvant therapy induces high response rates in the primary site and nodal melanoma.
- •Consider postponing resection of the primary site melanoma to after neoadjuvant therapy.
Abstract
Background
Patients with synchronous clinical stage III melanoma can present with primary melanoma
lesions, locally recurrent melanoma or in-transit metastases. Neoadjuvant ipilimumab
plus nivolumab induces high pathologic response rates and an impressive relapse-free
survival in patients with nodal macroscopic stage III melanoma. Whether primary site
melanoma and in-transit metastases respond similarly to lymph node metastases with
neoadjuvant immunotherapy is largely unknown. Such data would clarify whether surgical
excision of these melanoma lesions should be performed before neoadjuvant therapy
or whether it could be deferred and performed in conjunction with lymphadenectomy
following neoadjuvant immunotherapy.
Patients
Patients with synchronous clinical stage III melanoma were identified from the OpACIN,
OpACIN-neo and PRADO neoadjuvant trials, where all patients were treated with ipilimumab
plus nivolumab. An additional case treated outside those clinical trials was included.
Results
Seven patients were identified; six patients had a concordant response in primary
site melanoma lesions or in-transit metastasis and the lymph node metastases. One
patient had concordant progression in both the primary and nodal tumour lesions and
developed stage IV disease during neoadjuvant treatment, and thus, no resection was
performed.
Conclusion
Pathologic response following neoadjuvant ipilimumab plus nivolumab in primary site
melanoma lesions or in-transit metastasis is concordant with a response in the lymph
node metastases, indicating that there may be no need to perform upfront surgery to
these melanoma lesions prior to neoadjuvant treatment.
Keywords
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Article info
Publication history
Published online: March 15, 2021
Accepted:
February 3,
2021
Received in revised form:
December 18,
2020
Received:
September 18,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
