Pooled Analysis of Neoadjuvant Therapy

Source: OncLive, August 2019

Jeffrey S. Weber, MD, PhD: And there was actually a compilation done, meaning a whole series of studies, and I think that’s an oral presentation. Hussein, what do we know about this compilation from this large group of neoadjuvant investigators?

Hussein A. Tawbi, MD, PhD: Actually, let me just back up a little bit. Again, remember what Vernon said. Those are patients who come to us with bulky nodal disease that’s either clinically detectable or on CT [computed tomography] scans, and those are patients with an extremely high risk of recurrence. And suddenly in melanoma we have the opportunity of having effective therapies in our hands, and so multiple institutions across multiple countries started some of these neoadjuvant trials. Again, we, at The University of Texas MD Anderson Cancer Center, did the neoadjuvant dabrafenib-trametinib trial, or we compared it with actual surgery and proved that there’s a 60-fold improvement in the relapsed-free survival.

Other collaborators have done immunotherapy-based trials, either of single-agent pembrolizumab, single-agent nivolumab, or ipilimumab-nivolumab, so we all actually collaborated on a 1-on-1 basis together, and at some point we realized that we actually can all come together and think about what would be the best way to conduct those trials and actually standardize the ways we conduct those trials. We even assess the pathologic complete response [CR] rate. This International Neoadjuvant Melanoma Consortium was formed a couple of years ago to kind of think through those issues and kind of help the field harmonize the approach. One of the first outcomes was actually a white paper describing for pathologists exactly how you classify a pathologic complete response, how you actually take the tumor, cut it and look at the slides and say, “This is what a pathologic CR looks like. This is what a partial response looks like.”