In a nutshell
This study wanted to find out what the best order is for treating melanoma with immunotherapy medications and surgery. The study found that immunotherapy before surgery resulted in better survival outcomes for these patients.
Treatments for melanoma have changed in the last few years. A newer treatment is called immune checkpoint blockade (ICB), which uses the immune system to kill the cancer cells. In many cases, the cancer is surgically removed. It is not clear if it is better to do ICB treatment before surgically removing the cancer, or after.
Methods & findings
This study included 59 patients. All the patients had stage three melanoma which had spread to the lymph nodes. Of the 59 patients, 18 had surgery, followed by ICB treatment. This method is called adjuvant therapy (AT). The remaining 41 patients had ICB treatment, followed by surgery. This method is called neoadjuvant therapy (NAT). The patients were followed for an average of 26 months.
After three years, patients in the NAT group had a slightly higher survival without signs of cancer (62%) compared to the AT group (31%). This difference was not statistically significant. However, patients who had NAT had a longer survival rate without the cancer coming back in areas far away from the primary tumor (metastasis). Patients in the NAT group had a 62% lower risk of cancer spreading to distant areas compared to the AT group.
The bottom line
The study concluded that neoadjuvant immunotherapy for melanoma may be associated with improvements in survival.
The fine print
This was a small study based on medical records. Larger, controlled studies are necessary for stronger evidence.
Published By :
Annals of Surgical Oncology
Jan 02, 2020