Does Neoadjuvant Immunotherapy Pathologic Complete Response Predict Better Outcomes in Melanoma?

This transcript has been edited for clarity.

Hello. I'm Dr Jeffrey Weber. I am a medical oncologist and the deputy director at the Laura and Isaac Perlmutter Cancer Center in New York City at the NYU Langone Medical Center.

Today I'd like to tell you about a couple of articles that appeared recently in Nature Medicine, which generally is a fairly basic publication, but these have significant clinical implications. There were two rather similar articles that made a very interesting point about the concept of neoadjuvant immunotherapy and melanoma.

The first was a randomized study that included only 20 patients—10 in each arm—with stage IIIB/IIIC resected melanoma, who received either neoadjuvant ipilimumab and nivolumab at the standard doses of 3 mg/kg and 1 mg/kg, respectively, for two courses.^[1] Then they had surgery and received two additional courses—that was the so-called neoadjuvant arm—versus the adjuvant arm, where all patients had surgery and then received four courses of the same therapy.

The interesting aspect of this study is that there was significant toxicity. Overall, nine out of 10 patients in each arm had grade 3/4 immune-related adverse events and they had great difficulty completing the therapy. All patients still got to surgery, but at the end of the day, this was a trial that had serious toxicity and it ended early.