Pathological Response and Toxicity of Neoadjuvant Immunotherapy in Advanced Melanoma.
Summary
This retrospective study evaluated the efficacy and safety of neoadjuvant immunotherapy in 24 patients with locally advanced resectable melanoma. Treatment primarily involved pembrolizumab monotherapy or a combination of ipilimumab and nivolumab. A pathological complete response (pCR) rate of 16.7% and a pathological partial response (pPR) rate of 33.3% were observed. NRAS codon 61 mutations were present in 42% of patients, with 50% of these achieving a pPR. Toxicity, particularly colitis with combination therapy, represented a significant clinical challenge.
Analysis
This real-world study confirms the feasibility and pathological response rates of neoadjuvant immunotherapy in advanced melanoma, aligning its findings with controlled trial data. The observation of a high prevalence of NRAS mutations and associated partial responses suggests a potential role for NRAS as a predictive biomarker, although progressions were noted, highlighting the need for improved patient selection. Toxicity management, particularly colitis induced by ipilimumab/nivolumab combination therapy, remains crucial for optimizing the benefits of this therapeutic approach.