Neoadjuvant Therapy in the Treatment of Melanoma

Source: OncLive, August 2019

Sanjiv S. Agarwala, MD: Dirk Schadendorf, I’d like to ask you specifically about 1 very interesting aspect with the combination of neoadjuvant T-VEC [talimogene laherparevec] and the immunotherapy. Very quickly if you could comment. It was a randomized trial.

Dirk Schadendorf, MD, PhD: It was a large randomized trial. One of the largest in neoadjuvant trials so far, with 150 patients randomized in 2 arms. T-VEC [talimogene laherparevec] in front, and then surgery in the first arm, and the control arm was surgery right away. And I think what was seen at the presentation at ASCO [American Society of Clinical Oncology Annual Meeting] is that there are several benefits in favor of the combination of up-front T-VEC [talimogene laherparevec] therapy, with improved rates of 0 resections…. The combination of 1 resection was also better; for the third 1, a it was 51% of the patients. So the resectability of the disease was much better.

And that also translated into a relapse-free survival rate at 1 year, which was 22% to 29%. So already after 1 year a clear benefit. The only small caveat I would see in that setting is that roughly 25% of the patients with a T-VEC [talimogene laherparevec] in front of patients have not made it to the planned surgery. And in the control arm, 7% of the patients did not undergo planned surgery. I think that’s a concern with all new adjuvant approaches: are you reaching the standard of care at the end?