Melanoma, is immunotherapy done before surgery useful?

My father had a melanoma removed and we are waiting to understand whether he should undergo immunotherapy to avoid a relapse or not. However, my cousins ​​raised a doubt in our minds: was it better to take the drugs before the operation? a better strategy?

He replies Paolo Asciertodirector of the Department of Melanoma Oncology, oncological immunotherapy and innovative therapies of the National Cancer Institute IRCCS Pascale Foundation of Naples (GO TO THE FORUM)

Rest assured: national guidelines currently indicate it as the therapeutic standard the administration of post-surgery immunotherapy (when indicated), starting from stage IIB-C of melanoma. Neoadjuvant therapy, i.e. that which is administered before the operation in clinically or radiologically evident disease, can only be prescribed within the clinical studies, or rather to patients who participate in a trial, with the precise aim of answering the question that you too have asked yourself. That is to say: Would taking pre-surgery medications lead to better results? At the Pascale Institute we have recently concluded the NEO-TIM study (coordinated by me) on neoadjuvant therapy in melanoma, the preliminary results of which are very promising.

Risk of relapse

Furthermore, previous studies demonstrate that, in cases of metastatic melanoma, pre-operative immunotherapy has a significant advantage for patients in terms of reduction of tumor cells in the involved tissue and, in 50% of cases, it can even make the use of adjuvant treatment superfluous, what is administered after the operation. Other studies go in this same direction and have highlighted benefits of neoadjuvant immunotherapy that would also extend to prevention of relapsesThis is unfortunately a very frequent occurrence in patients undergoing surgery for high-risk melanoma (stage III and IV). In fact, over 60-70% of these patients experience a relapse within five years of diagnosisbut the risk is halved with post-surgery immunotherapy and may decrease further with the addition of pre-surgery immunotherapy.

Studies in progress

A recent study published in New England Journal of Medicineconducted on over 300 patients, has in fact demonstrated that in this way the risk of a relapse drops by 20%.: 72% of patients treated with the addition of pre-operative immunotherapy were free of recurrence five years after diagnosis, compared to 42% of those who received the drugs only after surgery. a paradigm shift supported by a growing body of research, not just for melanoma: There are approximately 50 ongoing phase III clinical trials of neoadjuvant immunotherapy for various types of cancer, from muscle-invasive bladder cancer and various breast cancers to gastrointestinal, ovarian, kidney, head and neck and lung cancers. And this change it would not have an additional cost to our National Health Service: the cycles of therapy administered earlier, in fact, would replace those currently administered later.

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