Neoadjuvant immunotherapy improves outlook in high-risk melanoma (Take pembrolizumab before surgery)

Medical Xpress / SWOG Cancer Research Network / Annals of Oncology ^ | Sept. 11, 2022 | Patel S et al.

[ConservativeMind]

Patients with high-risk melanoma who received the immunotherapy drug pembrolizumab both before and after surgery to remove cancerous tissue had a significantly lower risk of their cancer recurring than similar patients who received the drug only after surgery.

"It's not just what you give, it's when you give it. The S1801 study demonstrates the same treatment for resectable melanoma given before surgery can generate better outcomes," Patel said. "In this case, we used the immune checkpoint inhibitor pembrolizumab. This treatment relies on the presence of pre-existing T cells coming in contact with cancer cells in the body to generate an immune response, and we found that starting treatment before the melanoma is removed—and with it the bulk of tumor-specific T cells—leads to a greater response than giving it after surgery."

Participants ages 18-90 were randomized to receive either upfront surgery followed by 200 mg of pembrolizumab every three weeks (known as adjuvant therapy) for a total of 18 doses, or to 200 mg of pembrolizumab every three weeks for three doses leading up to surgery (known as neoadjuvant therapy), then an additional 15 doses following surgery.

With a median follow-up of 14.7 months, event-free survival was significantly longer in the neoadjuvant therapy arm, with a hazard ratio of 0.58 when compared to the adjuvant therapy arm, which corresponds to a 42% lower event rate in the patients receiving the neoadjuvant regimen.

"Our study noted a significant improvement in event-free survival in the neoadjuvant regimen compared to the adjuvant regimen," Patel said. "Importantly, a similar number of patients in both arms experienced events before initiating adjuvant pembrolizumab, but the rate of events after initiating adjuvant therapy was higher (worse) in the adjuvant arm."

[ConservativeMind]

There is a great survival improvement in receiving pembrolizumab, an immunotherapy, before surgery, seemingly due to allowing your body to better identify the cells before they are eliminated. Normally, immunotherapy makes the body respond “primarily to micrometastatic cancer cells,” otherwise.

[ConservativeMind]

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