Paolo Ascierto, Full Professor of Oncology at the University of Naples Federico II, Director of the Department of Melanoma, Cancer Immunotherapy and Development Therapeutics at the National Cancer Institute IRCCS Pascale Foundation, shared a post on LinkedIn:

“Why does immunotherapy work better in the neoadjuvant setting than in the adjuvant one?

This is the key question we address in our new commentary with Ignacio Melero, now published in Journal for ImmunoTherapy of Cancer.

Despite the success of anti-PD-1 therapy in adjuvant melanoma, multiple phase III trials combining checkpoint inhibitors have failed.
Our view is simple, but biologically grounded: in minimal residual disease there is little or no tumor antigen, and therefore little immune priming.

Checkpoint blockade can reinvigorate T cells, but only if priming has already occurred.
In the adjuvant setting, that priming step is often missing.

This explains why combinations effective in metastatic disease do not add benefit after surgery, while strategies that actively induce priming (such as mRNA vaccines or selected targeted therapies) show promise.
Adjuvant immunotherapy must evolve from passive maintenance to active immunization.

It all starts with priming!”

Title: Reframing adjuvant immunotherapy in melanoma: all of it starts with priming