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Andrea Boutros: Neoadjuvant therapy is likely to become the standard for stage III Melanoma Treatment

Andrea Boutros/X

Dec 31, 2024, 09:45

Andrea Boutros: Neoadjuvant therapy is likely to become the standard for stage III Melanoma Treatment

Andrea Boutros, Medical Doctor and Oncology Resident at San Martino Polyclinic Hospital, shared on X:

“Future of Stage III Melanoma Treatment.

The paradigm for managing stage III melanoma is shifting. In our recent ASCO Daily News, we argue that neoadjuvant therapy is likely to become the standard, leaving adjuvant therapy with a limited role.

Neoadjuvant immune checkpoint inhibitors deliver:

Pathologic response as a surrogate for long-term outcomes.
A 42-68% reduction in EFS vs. adjuvant anti–PD1.
Tailored post-surgery treatments based on response.

Reducing overtreatment for patients with macroscopic disease.

Adjuvant Therapy: Losing Relevance?

Increased for microscopic disease (e.g., sentinel node-positive): Anti–PD1 and BRAF/MEKi reduce recurrence risk by ~50%.

Decreased BUT: No demonstrated OS benefit. In stage IIIA, the benefit is particularly questionable, with overtreatment likely significant.

Neoadjuvant allows: De-escalation opportunities for responders (major pathologic response). Shorter, less toxic regimens: 2-3 cycles instead of 12 months.

This marks a shift to precision care, sparing many patients from prolonged therapy.

Adjuvant therapy is equal to you only know it worked when it doesn’t work.
Neoadjuvant therapy is equal offers real-time efficacy assessment, better outcomes, and patient-centred precision care.

The future of stage III melanoma is neoadjuvant therapy, with adjuvant limited to select cases.

What’s your view on the decline of adjuvant therapy for melanoma?

Let’s discuss how to improve precision in patient selection and therapy.

Thanks Georgina Long, Melanoma Institute Australia.”