Stage III Melanoma: Neoadjuvant Therapy

Source: OncLive, August 2019

Jeffrey S. Weber, MD, PhD: Talking about personalizing, which is sort of the hot topic in melanoma, locoregional treatment is the issue of neoadjuvant therapy. Vern, can you tell me a little bit about the REDUCTOR trial, which again is an ASCO [American Society of Clinical Oncology Annual Meeting] abstract that I think will be discussed this afternoon. It’s basically BRAF/MEK neoadjuvant therapy, which I think has had at least 1 very nice publication and could be a practice-changing discovery. What can you tell us?

Vernon K. Sondak, MD: First of all, as we just heard, adjuvant therapy is helping patients. Adjuvant therapy is helping patients with high-risk melanoma to delay or even prevent recurrence. And it clearly helps prevent local and regional recurrence, as well as distant recurrence. So all the advantages of adjuvant therapy are there. Some patients can benefit by neoadjuvant therapy, getting the drugs before surgery, in that they also have an easier operation. We can shrink large tumors down, make the surgery potentially easier, perhaps not need postoperative radiation or other treatments. But we also get another very important advantage of neoadjuvant therapy, and that is we see whether it works.

You’ve all talked about the risk-benefit discussions you’re having with the patient—treat now, treat later. Give these people a year of adjuvant therapy, and you have no idea whether it did anything—whether they were cured, whether they were resistant. You don’t know until it’s too late.