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Review
. 2024 Aug;26(8):924-933.
doi: 10.1007/s11912-024-01556-z. Epub 2024 Jun 6.

Management of Localized Melanoma in the Anti-PD-1 Era

Elan Novis  1   2 , Alexander C J van Akkooi  3   4   5
Affiliations
Review

Management of Localized Melanoma in the Anti-PD-1 Era

Elan Novis et al. Curr Oncol Rep. 2024 Aug.

Abstract

Purpose of review: The management of cutaneous melanoma has rapidly progressed over the past decade following the introduction of effective systemic therapies. Given the large number of recent clinical trials which have dramatically altered the management of these patients, an updated review of the current evidence regarding the management of localized melanoma is needed.

Recent findings: The role of effective systemic therapies in earlier stages (I-III) melanoma, both in adjuvant and neoadjuvant settings is rapidly changing the role of surgery in the management cutaneous melanoma, particularly regarding surgical safety margins for wide local excision (WLE), the role of sentinel lymph node biopsy (SLNB) and the extent of lymph node dissections. The randomized phase 2 SWOG1801 trial has demonstrated superiority of neoadjuvant-adjuvant anti-PD1 therapy in improving event-free survival by 23% at 2-years over adjuvant anti-PD-1 therapy only. Furthermore, the PRADO trial has suggested a more tailored approach both the extent of surgery as well as adjuvant therapy can safely and effectively be done, depending on the response to initial neoadjuvant immunotherapy. These results await validation and it is expected that in 2024 the phase 3 Nadina trial (NCT04949113) will definitively establish neo-adjuvant combination immunotherapy as the novel standard. This will further redefine the management of localized melanoma. The use of effective systemic therapies will continue to evolve in the next decade and, together with new emerging diagnostic and surveillance techniques, will likely reduce the extent of routine surgery for stage I-III melanoma.

Keywords: Adjuvant; Cutaneous melanoma; Immunotherapy; Lymph Node; Neoadjuvant; Sentinel Node; Targeted therapy.

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Conflict of interest statement

EN has no conflicts of interest to disclose. AvA declares: Advisory Board/Consultancy Honoraria 4SC AG, Amgen, Bristol-Myers Squibb, Merck Serono-Pfizer, MSD-Merck, Neracare, Novartis, Pierre Fabre, Sanofi, Sirius Medical, SkylineDX.

Figures

Fig. 1
Fig. 1
Two case studies demonstrating the importance of SLNB in calculating prognosis and determining benefit from adjuvant systemic therapy
Fig. 2
Fig. 2
Proposed Phase 3 Prospective RCT to compare ILN resection to TLND following NAST
See this image and copyright information in PMC

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