When Is Surgery the Optimal Adjuvant Treatment?
Menée à partir de données portant sur 82 patients atteints d'un mélanome de stade III traité par immunothérapie néoadjuvante (ipilimumab + nivolumab) puis lymphadénectomie (âge médian : 58,5 ans ; 59 % d'hommes), cette étude analyse la concordance entre la réponse pathologique évaluée au niveau de la plus grande métastase ganglionnaire (identifiée par imagerie avant l'immunothérapie néoadjuvante) et la réponse pathologique évaluée au niveau de chaque ganglion réséqué
The holy grail of any therapeutic regimen is to identify the option that has the greatest effectiveness with the least morbidity. As systemic treatment continues to demonstrate improved survival for patients with advanced melanoma, expanded use in the neoadjuvant setting for bulky, but resectable, stage III disease was to be expected. The OpACIN study found that no patients with pathological responses to ipilimumab plus nivolumab relapsed after median follow-up of 32 months. Further, a pooled analysis from the International Neoadjuvant Melanoma Consortium found that patients with a pathologic complete response with immunotherapy had very few relapses. It is not surprising that these data have motivated considerations for eliminating therapies that may not benefit patients, namely therapeutic lymphadenectomy.
JAMA Surgery , éditorial, 2021