Dr. Blank on Adjuvant Versus Neoadjuvant Approaches in Stage III Melanoma

Christian U. Blank, MD, PhD, medical oncologist in the Division of Immunology at the Netherlands Cancer Institute, discusses adjuvant versus neoadjuvant approaches in macroscopic stage III melanoma.

The melanoma field has efficacious adjuvant approaches available for use, with targeted therapies, such as trametinib (Mekinist), and immunotherapies, such as pembrolizumab (Keytruda) and nivolumab, says Blank.

The relapse-free survival (RFS) for patients with stage III melanoma in the macroscopic setting is within the range of 60% and 70%, according to Blank. However, the problem is that all these trials within this patient population have excluded patients who experience early relapse. Patients who relapsed following surgery before they began adjuvant therapy at week 12 were excluded from these trials. As such, the RFS in the intention-to-treat population, or event-free survival, is estimated to range from 15% to 25%, according to Blank.

With neoadjuvant therapy, patients have the advantage of starting treatment with immunotherapy when the whole tumor is still present; that means a broader and more intense immune response can be induced compared with if the entire tumor was removed and only the smoldering small tumor cells were present. Those cells are sometimes not particularly immunogenic; thus, a lower immune response would be produced, concludes Blank.