Dr Hauschild on the Role of Adjuvant/Neoadjuvant Therapy in Melanoma Management

Axel Hauschild, MD, PhD, head, Skin Cancer Trial Center, University Hospital Schleswig-Holstein, discusses the role of adjuvant and neoadjuvant therapy in melanoma management, as well as highlights the benefits and limitations of perioperative treatment approaches in this disease setting.

The utility of adjuvant and neoadjuvant treatment in patients with melanoma has evolved over the past 5 to 10 years, Hauschild begins. Adjuvant treatments, including PD-1 antibodies as well as BRAF and MEK inhibitors, have yielded notable improvements in relapse-free survival for patients, he states. However, recent data with neoadjuvant ipilimumab (Yervoy) and nivolumab (Opdivo) in patients with resectable stage III disease and lymph node metastases are equally compelling, Hauschild reports. Neoadjuvant treatment can result in complete responses (CRs) confirmed by histopathology, potentially eliminating the need for adjuvant therapy, he explains. Accordingly, these patients are spared its associated toxicities, although neoadjuvant therapy also carries its own adverse effects, Hauschild adds. 

The use of a neoadjuvant, adjuvant, or perioperative approaches is often dependent on physician preference, cost considerations, and patient factors, Hauschild continues. He considers perioperative treatment to be a beneficial approach, as it involves a similar number of cycles and toxicity profile as adjuvant therapy without additional costs. For example, perioperative pembrolizumab (Keytruda) is administered for 1 year, with 3 cycles given before surgery and the remaining cycles administered post-surgery. This schema is appealing for its practicality and potential effectiveness, Hauschild states. Nevertheless, a neoadjuvant only regimen should be considered for patients achieving pathologically confirmed CRs, he reiterates.

Both neoadjuvant and adjuvant treatment modalities are likely to play integral roles in future melanoma management, Hauschild emphasizes. Randomized phase 3 clinical trials leading to the approval of more neoadjuvant or adjuvant approaches are highly anticipated in Germany, as in many other countries. Therefore, the continued exploration and validation of these therapies through rigorous clinical trials are crucial for their integration into standard practice and essential for proper reimbursement, Hauschild concludes.