Proffered paper session: Melanoma and other skin tumours

Prof Bart Neyns, medical oncologist at UZ Brussel shares the key insights from the proffered paper session. 

An updated pooled analysis from INMC with a three-year follow-up of patients treated with a neoadjuvant approach, both within prospective clinical trials and in real-world settings outside of trial protocols, was presented. Neoadjuvant therapy has garnered significant attention in the management of melanoma, particularly for patients diagnosed with macroscopic lymph node metastasis. In such cases, at the time of primary melanoma diagnosis, the lymph nodes are already enlarged due to metastatic spread from the primary tumour. Historically, the standard treatment consisted solely of surgical resection, followed by adjuvant therapy administered over the course of a year to reduce the risk of relapse. 

Recent developments in melanoma management, however, have seen a shift in treatment paradigms, particularly in specialized centres, from postoperative to preoperative interventions. One of the advantages of neoadjuvant therapy is that following a short course of medical treatment, surgical resection of the affected lymph nodes allows for direct pathological assessment of the tumour response. It has been confirmed that radiological evaluations may not reliably predict therapeutic outcomes. Instead, a higher proportion of patients demonstrate a pathological response, categorised as partial, near-complete, or complete, upon histological examination of the resected lymph node metastases. This finding reinforces the efficacy of neoadjuvant approaches in the treatment of melanoma. 

An important finding from this analysis is the identification of a surrogate marker, based on pathological response, that can help identify patients who respond exceptionally well to neoadjuvant therapy and may not require subsequent adjuvant treatment. The NADINA trial, which treated patients with two cycles of ipilimumab (1 mg/kg) and nivolumab (3 mg/kg) to minimize toxicities, demonstrated that approximately 60% of patients in the experimental arm achieved either a near-complete or complete pathological response. Remarkably, these patients did not require additional therapy post-surgery.

Updated follow-up data confirmed that these patients continue to show significantly better outcomes compared to the control arm, which received standard adjuvant treatment. For the first time, distant metastasis-free survival has also been reported and shows marked improvement in the experimental group. This highlights the robustness of the neoadjuvant approach not only in controlling locoregional disease but also in preventing the spread of melanoma to distant sites. These findings suggest that neoadjuvant therapy should be considered as a potential standard of care for patients with macroscopic lymph node metastasis in melanoma. The ability to tailor post-surgical treatment based on pathological response further enhances the precision and effectiveness of this approach.