Judith M Versluis1, Irene L M Reijers1, Elisa A Rozeman1, Alexander M Menzies2, Alexander C J van Akkooi3, Michel W Wouters3, Sydney Ch'ng4, Robyn P M Saw4, Richard A Scolyer5, Bart A van de Wiel6, Bastian Schilling7, Georgina V Long2, Christian U Blank8. 1. Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. 2. Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Royal North Shore and Mater Hospitals, 25 Rocklands Rd, North Sydney NSW 2060, Australia. 3. Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. 4. Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia. 5. Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft NSW 2065, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney NSW 2006, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia. 6. Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands. 7. Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany. 8. Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, the Netherlands. Electronic address: c.blank@nki.nl.
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.
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: Frank Rojas; Edwin Roger Parra; Ignacio Ivan Wistuba; Cara Haymaker; Luisa Maren Solis Soto Journal: Cancers (Basel) Date: 2022-06-02 Impact factor: 6.575