Nivolumab combined with Ipilimumab followed by curative-intent surgery was evaluated as a treatment strategy for patients with locoregional relapse of Melanoma after adjuvant therapy in a study presented at the ESMO Sarcoma and Rare Cancers Congress 2026. The analysis explored outcomes in this rare clinical setting, where evidence guiding management after failure of adjuvant treatment remains limited.
Authors: Anna Mariuk-Jarema, Pawel Teterycz , Karolina Sosnowska, Hanna Kosela-Paterczyk, Pawel Rogala, Katarzyna Kozak, Anna M. Szumera-Cieckiewicz, Piotr Rutkowski
Background
Immune checkpoint inhibitors and targeted therapies with BRAF and MEK inhibitors have become standard treatments for Melanoma across several disease stages. However, the optimal management of patients who develop locoregional relapse after or during adjuvant therapy remains unclear. Understanding how best to treat these patients is particularly important because treatment options in this setting are not well defined. This study investigated whether induction immunotherapy with nivolumab plus ipilimumab followed by surgical resection could serve as an effective treatment strategy after failure of adjuvant therapy.
Methods
This single-center retrospective study included patients with stage III melanoma who received adjuvant therapy after surgical resection and subsequently developed locoregional relapse.
Eligible patients were treated with induction nivolumab plus ipilimumab followed by curative-intent surgical resection. Baseline characteristics and treatment outcomes were obtained from electronic health records.
Results
A total of 12 patients were included in the analysis, with a mean age of 57 years and 33% female patients. Half of the cohort had BRAFV600-mutated melanoma and received BRAF/MEK inhibitor therapy as adjuvant treatment, while the remaining patients had BRAF wild-type disease and received anti–PD-1 therapy in the adjuvant setting.
Among the cohort, six patients experienced relapse during adjuvant therapy, while the remaining patients relapsed after completing adjuvant treatment, with a median time to progression of 14.9 months.The median interval between initiation of nivolumab plus ipilimumab and surgery was 2.1 months.
Pathological responses were observed in several patients, with complete or major pathological response achieved in four cases. Importantly, no correlation was observed between radiological response assessed by RECIST 1.1 prior to surgery and pathological response.At three years after initiation of combination immunotherapy, the progression-free survival rate was 55%, while the overall survival rate reached 92%.Outcomes did not differ according to BRAF mutation status, and notably no patients who achieved a major pathological response experienced relapse or death during follow-up.
Clinical Implications
These findings suggest that nivolumab plus ipilimumab followed by surgery may represent an effective salvage strategy for patients with locoregional melanoma relapse after adjuvant therapy, regardless of prior treatment or BRAF mutation status.The lack of correlation between radiological and pathological response highlights the potential importance of surgical evaluation even when imaging does not indicate a strong response, emphasizing the role of multidisciplinary management in this challenging clinical setting.