Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic Review
Despite advances in adjuvant immuno- and targeted therapies, the risk of relapse for stage III melanoma remains high. With 43 active entries on clinicaltrials.gov (8 July 2020), there is a surge of interest in the role of contemporary therapies in the neoadjuvant setting. We conducted a systematic r...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/8/1905 |
| _version_ | 1797537572370513920 |
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| author | Kerianne Boulva Sameer Apte Ashley Yu Alexandre Tran Risa Shorr Xinni Song Michael Ong Carolyn Nessim |
| author_facet | Kerianne Boulva Sameer Apte Ashley Yu Alexandre Tran Risa Shorr Xinni Song Michael Ong Carolyn Nessim |
| author_sort | Kerianne Boulva |
| collection | DOAJ |
| description | Despite advances in adjuvant immuno- and targeted therapies, the risk of relapse for stage III melanoma remains high. With 43 active entries on clinicaltrials.gov (8 July 2020), there is a surge of interest in the role of contemporary therapies in the neoadjuvant setting. We conducted a systematic review of trials performed in the last decade evaluating neoadjuvant targeted, immuno- or intralesional therapy for resectable stage III or IV melanoma. Database searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials were conducted from inception to 13 February 2020. Two reviewers assessed titles, abstracts, and full texts. Trials investigating contemporary neoadjuvant therapies in high-risk melanoma were included. Eight phase II trials (4 randomized and 4 single-arm) involving 450 patients reported on neoadjuvant anti-BRAF/MEK targeted therapy (3), anti-PD-1/CTLA-4 immunotherapy (3), and intralesional therapy (2). The safest and most efficacious regimens were dabrafenib/trametinib and combination ipilimumab (1 mg/kg) + nivolumab (3 mg/kg). Pathologic complete response (pCR) and adverse events were comparable. Ipilimumab + nivolumab exhibited longer RFS. Contemporary neoadjuvant therapies are not only safe, but also demonstrate remarkable pCR and RFS—outcomes which are regarded as meaningful surrogates for long-term survival. Studies defining predictors of pCR, its correlation with oncologic outcomes, and phase III trials comparing neoadjuvant therapy to standard of care will be crucial. |
| first_indexed | 2024-03-10T12:18:06Z |
| format | Article |
| id | doaj.art-25a9509af0184a9fbce579a112194a43 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T12:18:06Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-25a9509af0184a9fbce579a112194a432023-11-21T15:42:02ZengMDPI AGCancers2072-66942021-04-01138190510.3390/cancers13081905Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic ReviewKerianne Boulva0Sameer Apte1Ashley Yu2Alexandre Tran3Risa Shorr4Xinni Song5Michael Ong6Carolyn Nessim7Division of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, CanadaDivision of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, CanadaDepartment of Family Medicine, McMaster University, Hamilton, ON L8P 1H6, CanadaDivision of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, CanadaThe Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, CanadaThe Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, CanadaThe Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, CanadaDivision of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, CanadaDespite advances in adjuvant immuno- and targeted therapies, the risk of relapse for stage III melanoma remains high. With 43 active entries on clinicaltrials.gov (8 July 2020), there is a surge of interest in the role of contemporary therapies in the neoadjuvant setting. We conducted a systematic review of trials performed in the last decade evaluating neoadjuvant targeted, immuno- or intralesional therapy for resectable stage III or IV melanoma. Database searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials were conducted from inception to 13 February 2020. Two reviewers assessed titles, abstracts, and full texts. Trials investigating contemporary neoadjuvant therapies in high-risk melanoma were included. Eight phase II trials (4 randomized and 4 single-arm) involving 450 patients reported on neoadjuvant anti-BRAF/MEK targeted therapy (3), anti-PD-1/CTLA-4 immunotherapy (3), and intralesional therapy (2). The safest and most efficacious regimens were dabrafenib/trametinib and combination ipilimumab (1 mg/kg) + nivolumab (3 mg/kg). Pathologic complete response (pCR) and adverse events were comparable. Ipilimumab + nivolumab exhibited longer RFS. Contemporary neoadjuvant therapies are not only safe, but also demonstrate remarkable pCR and RFS—outcomes which are regarded as meaningful surrogates for long-term survival. Studies defining predictors of pCR, its correlation with oncologic outcomes, and phase III trials comparing neoadjuvant therapy to standard of care will be crucial.https://www.mdpi.com/2072-6694/13/8/1905melanomaneoadjuvanttargeted therapyimmunotherapyintralesional therapy |
| spellingShingle | Kerianne Boulva Sameer Apte Ashley Yu Alexandre Tran Risa Shorr Xinni Song Michael Ong Carolyn Nessim Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic Review Cancers melanoma neoadjuvant targeted therapy immunotherapy intralesional therapy |
| title | Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic Review |
| title_full | Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic Review |
| title_fullStr | Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic Review |
| title_full_unstemmed | Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic Review |
| title_short | Contemporary Neoadjuvant Therapies for High-Risk Melanoma: A Systematic Review |
| title_sort | contemporary neoadjuvant therapies for high risk melanoma a systematic review |
| topic | melanoma neoadjuvant targeted therapy immunotherapy intralesional therapy |
| url | https://www.mdpi.com/2072-6694/13/8/1905 |
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