Neoadjuvant ipilimumab plus nivolumab in synchronous clinical stage III melanoma.

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.

• Authors: Judith M Versluis, Irene L M Reijers, Elisa A Rozeman, Alexander M Menzies, Alexander C J van Akkooi, Michel W Wouters, Sydney Ch'ng, Robyn P M Saw, Richard A Scolyer, Bart A van de Wiel, Bastian Schilling, Georgina V Long, Christian U Blank
• Journal: European journal of cancer (Oxford, England : 1990) (Eur J Cancer) Vol. 148 Pg. 51-57 (05 2021) ISSN: 1879-0852 [Electronic] England
• PMID: 33735809 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier Ltd. All rights reserved.

Chemical References

• Ipilimumab
• Nivolumab

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Ipilimumab (administration & dosage)
• Male
• Melanoma (drug therapy, pathology)
• Middle Aged
• Neoadjuvant Therapy (mortality)
• Neoplasm Recurrence, Local (drug therapy, pathology)
• Neoplasm Staging
• Neoplasms, Multiple Primary (drug therapy, pathology)
• Nivolumab (administration & dosage)
• Retrospective Studies
• Survival Rate