Neoadjuvant ipilimumab plus nivolumab in synchronous clinical stage III melanoma.

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.

Informations de copyright

Copyright © 2021 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of interest statements The authors declare the following financial interests/personal relationships that may be considered as potential competing interests: All authors declare no direct conflicts with this work. For unrelated conflicts, AMM reports an advisory role for Bristol-Myers Squibb, MSD Oncology, Novartis, Pierre Fabre and Roche. ACJvA has received advisory board and consultancy honoraria from Amgen, Bristol-Myers Squibb, Novartis, MSD-Merck, Merck-Pfizer, Sanofi and 4SC, all paid to the institute; and research grants received from Amgen, Bristol-Myers Squibb, Merck-Pfizer and Novartis, all paid to the institute. RPMS has received honoraria for advisory board participation from Merck, Sharpe & Dome, Novartis and Qbiotics and speaking honoraria from Bristol-Myers Squibb. RAS has received fees for professional services from Qbiotics Group Limited, Novartis, NeraCare, AMGEN Inc., Bristol-Myers Squibb, Myriad Genetics GmbH, GlaxoSmithKline Australia and Merck Sharp & Dohme. BS has received personal honoraria from Bristol-Myers Squibb, Merck Sharpe & Dome, Novartis, Pfizer/EMD Serono, Pierre Fabre and Roche; has an advisory role for Bristol-Myers Squibb, Merck Sharpe & Dome, Novartis, Pierre Fabre and Roche; and has received research funding from Bristol-Myers Squibb, Merck Sharpe & Dome, and Pierre Fabre, all paid to the institute. GVL is consultant advisor for Aduro, Amgen, Bristol-Myers Squibb, Highlight Therapeutics S.L., Mass-Array, Merck, MSD, Novartis, OncoSec Medical, Pierre Fabre, Roche, QBiotics, Skyline DX and Sandoz. CUB has received research funding from Bristol-Myers Squibb, Novartis and NanoString, all paid to the institute; has an advisory role for Bristol-Myers Squibb, Merck Sharpe & Dome, Roche, Novartis, GlaxoSmithKline, AstraZeneza, Pfizer, Lilly, GenMab and Pierre Fabre; and is stockowner of Uniti Cars.