Neoadjuvant therapy of melanoma

With the emergence of immune checkpoint inhibitors and targeted therapies, significant progress has been made in the systemic treatment of melanoma. These advancements are now extended to the neoadjuvant setting to manage locally advanced disease. Particularly the use of PD-1 blockade alone or in combination with CTLA-4 blockade has shown promising results in terms of reducing the risk of relapse and mortality. Initial data also show that neoadjuvant immunotherapy allows de-escalation of lymph node surgery. Similarly, neoadjuvant BRAF-MEK inhibition for melanoma with BRAF mutations has produced comparable outcomes, although the response durability is lower compared to immunotherapy. Moreover, the S1801 randomized trial has provided the first evidence of the advantages of the neoadjuvant approach over the conventional approach of surgery followed by adjuvant therapy.