Highlights on melanoma/skin cancer 1

Prof Dr Jean-François Baurain, a medical oncologist at the Cliniques Universitaires Saint-Luc, Brussels presents a first selection of interesting highlights in melanoma and skin cancer.

The COMBI-AD study assessed adjuvant treatment with dabrafenib plus trametinib for patients diagnosed with BRAF-mutated AJCC-stage III melanoma. Final outcomes were disclosed following a follow-up period exceeding 10 years. While OS showed improvement with dabrafenib plus trametinib versus placebo, this difference did not achieve statistical significance. Relapse-free survival and DMFS exhibited a plateau around 50%.

A 3-year update of the KEYNOTE 942 study has been presented by Jeffrey Weber and demonstrated sustained and clinically significant long-term benefits in RFS and DMFS with mRNA-4157 in combination with pembrolizumab compared to pembrolizumab alone. Additionally, there was an observed trend towards improved OS with the combination treatment regimen.

In the NADINA trial, patients with resectable, macroscopic stage III melanoma who had not received prior treatment with immune or targeted therapy, underwent neoadjuvant immunotherapy comprising ipilimumab (IPI) plus nivolumab (NIVO), followed by TLND. For patients who did not achieve a MPR following neoadjuvant treatment, adjuvant therapy was administered. The results revealed a statistically significant improvement in EFS with neoadjuvant IPI plus NIVO followed by response-driven adjuvant therapy compared to adjuvant NIVO alone. Consequently, this approach should be regarded as a new SOC treatment for individuals with macroscopic stage III melanoma.

The De-Squamate study, utilizing neoadjuvant pembrolizumab, showcased the viability of a risk-tailored surgical de-escalation approach, guided by assessments of clinical, radiological, and pathological response, in individuals with rcSCC across various anatomical sites.

The NEO-TIM study, a randomized, non-comparative phase II trial, aimed to define the role of neoadjuvant treatment plus adjuvant treatment (targeted therapy and immunotherapy), given in combination or sequence, in patients with high-risk surgically resectable melanoma. Although the primary endpoint of achieving a pCR was not attained in any of the treatment arms, patients who underwent neoadjuvant immunotherapy exhibited improved RFS.