Neoadjuvant systemic therapy for regionally advanced melanoma

James W Jakub, Jennifer M. Racz, Tina J Hieken, Alexandra B. Gonzalez, Lisa A. Kottschade, Svetomir Nenad Markovic, Yiyi Yan, Matthew S Block

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Patients with regionally advanced melanoma are at high risk of distant failure and unlikely to be cured by surgery alone. Neoadjuvant therapy may provide benefit in these patients. Objectives: To evaluate our experience with neoadjuvant systemic therapy in high-risk stage III patients. Methods: Retrospective review of patients with advanced stage III disease who received neoadjuvant therapy between August 2009 and August 2016 at Mayo Clinic Rochester. Results: Twenty-three cases met our inclusion criteria, 16 with resectable disease and 7 with unresectable disease. No patients with resectable disease and one patient with borderline resectable disease progressed regionally, prohibiting surgical resection. Five of seven patients with unresectable disease were down-staged to a resectable state. Six of twenty-three (26%) had a CR and five are alive at last follow-up. Fifteen of twenty three patients (65%) progressed with a median progression free survival of 11 months; however, the 5 year overall survival estimate was 84%. Conclusions: Neoadjuvant systemic therapy is a reasonable approach for patients with advanced but resectable/borderline resectable disease and the risk of losing regional control is low. Our data also suggest some patients with unresectable disease will be converted to resectable and a complete clinical response to treatment can be obtained in approximately one quater of patients.

Original languageEnglish (US)
Pages (from-to)1164-1169
Number of pages6
JournalJournal of Surgical Oncology
Volume117
Issue number6
DOIs
StatePublished - May 1 2018

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Neoadjuvant Therapy
Melanoma
Disease-Free Survival

Keywords

  • adjuvant
  • complete response
  • CTLA-4
  • ipilimumab
  • PD-1
  • pembrolizumab

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Neoadjuvant systemic therapy for regionally advanced melanoma. / Jakub, James W; Racz, Jennifer M.; Hieken, Tina J; Gonzalez, Alexandra B.; Kottschade, Lisa A.; Markovic, Svetomir Nenad; Yan, Yiyi; Block, Matthew S.

In: Journal of Surgical Oncology, Vol. 117, No. 6, 01.05.2018, p. 1164-1169.

Research output: Contribution to journalArticle

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abstract = "Background: Patients with regionally advanced melanoma are at high risk of distant failure and unlikely to be cured by surgery alone. Neoadjuvant therapy may provide benefit in these patients. Objectives: To evaluate our experience with neoadjuvant systemic therapy in high-risk stage III patients. Methods: Retrospective review of patients with advanced stage III disease who received neoadjuvant therapy between August 2009 and August 2016 at Mayo Clinic Rochester. Results: Twenty-three cases met our inclusion criteria, 16 with resectable disease and 7 with unresectable disease. No patients with resectable disease and one patient with borderline resectable disease progressed regionally, prohibiting surgical resection. Five of seven patients with unresectable disease were down-staged to a resectable state. Six of twenty-three (26{\%}) had a CR and five are alive at last follow-up. Fifteen of twenty three patients (65{\%}) progressed with a median progression free survival of 11 months; however, the 5 year overall survival estimate was 84{\%}. Conclusions: Neoadjuvant systemic therapy is a reasonable approach for patients with advanced but resectable/borderline resectable disease and the risk of losing regional control is low. Our data also suggest some patients with unresectable disease will be converted to resectable and a complete clinical response to treatment can be obtained in approximately one quater of patients.",
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