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Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice.

Publication ,  Journal Article
Rhodin, KE; Gaughan, EM; Raman, V; Salama, AK; Hanks, BA; Shah, R; Tyler, DS; Slingluff, CL; Beasley, GM
Published in: Ann Surg
July 7, 2022

OBJECTIVE: To determine the feasibility and impact of neoadjuvant therapy (NT) in patients who present with advanced melanoma amenable to surgical resection. SUMMARY BACKGROUND DATA: Given current effective systemic therapy for melanoma, the use of NT is being explored in patients with advanced melanoma with disease amenable to surgical resection. METHODS: Prospective data from 3 institutions was obtained in patients with clinically evident Stage III/IV melanoma who underwent NT. The primary objective was to compare recurrence-free survival between patients who had pathologic complete response (pCR) to those with persistent disease. RESULTS: NT was offered to 45 patients, with 43 patients initiating various NT regimens including PD-1 antagonist (PD-1) therapy (N = 16), PD-1 plus ipilimumab (N = 10), BRAF/MEK inhibitor therapy (N = 14), a combination of those three (N = 1), and talimogene laherparepvec (TVEC) (N = 2). Thirty-two (74.1%) patients underwent surgery whereas 11 patients did not undergo surgery for these reasons: clinical CR (N = 7), progressive disease not amenable to resection (N = 3), and ongoing therapy (N = 1). 12 of 32 patients (37.5%) had pCR with these therapies: PD-1 (N = 4), PD-1 plus ipilimumab (N = 2), BRAF/MEK (N = 4), combination (N = 1), and TVEC (N = 1). At median follow-up of 16.4 months there was only 1 recurrence in the pCR group and patients with a pCR had significantly improved recurrence-free survival compared to patients without pCR (p = 0.004). CONCLUSIONS: Despite variability in NT regimens across institutions, NT for melanoma is feasible and associated with improved prognosis in patients who achieve a pCR. Maximizing rates of pCR could improve prognosis for patients with advanced melanoma.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

July 7, 2022

Location

United States

Related Subject Headings

  • Surgery
  • 11 Medical and Health Sciences
 

Citation

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Rhodin, K. E., Gaughan, E. M., Raman, V., Salama, A. K., Hanks, B. A., Shah, R., … Beasley, G. M. (2022). Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice. Ann Surg. https://doi.org/10.1097/SLA.0000000000005459
Rhodin, Kristen E., Elizabeth M. Gaughan, Vignesh Raman, April K. Salama, Brent A. Hanks, Riddhishkumar Shah, Douglas S. Tyler, Craig L. Slingluff, and Georgia M. Beasley. “Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice.Ann Surg, July 7, 2022. https://doi.org/10.1097/SLA.0000000000005459.
Rhodin KE, Gaughan EM, Raman V, Salama AK, Hanks BA, Shah R, et al. Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice. Ann Surg. 2022 Jul 7;
Rhodin, Kristen E., et al. “Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice.Ann Surg, July 2022. Pubmed, doi:10.1097/SLA.0000000000005459.
Rhodin KE, Gaughan EM, Raman V, Salama AK, Hanks BA, Shah R, Tyler DS, Slingluff CL, Beasley GM. Multicenter Experience with Neoadjuvant Therapy in Melanoma Highlights Heterogeneity in Contemporary Practice. Ann Surg. 2022 Jul 7;

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

July 7, 2022

Location

United States

Related Subject Headings

  • Surgery
  • 11 Medical and Health Sciences