Standard neoadjuvant immunotherapy in patients with resectable stage III Melanoma - The early Australian experience
- Author(s)
- Proulx-Rocray, F; Symons, R; Wang, Y; Liaqat, S; Warburton, L; Jiang, C; Wong, T; Hsiao, E; Ch'ng, S; Shannon, KF; Rtshiladze, M; Pennington, TE; Coker, DJ; Carlino, MS; Spillane, A; Stretch, J; Saw, RPM; van Akkooi, ACJ; Snow, H; Gyorki, DE; Spain, L; Jackett, LA; Atkinson, V; Roberts-Thomson, R; Dzienis, M; Khattak, A; Sandhu, S; Rawson, RV; Lo, SN; Long, GV; Menzies, AM;
- Journal Title
- European Journal of Cancer
- Publication Type
- Research article
- Abstract
- BACKGROUND: Neoadjuvant immune checkpoint inhibitor therapy (nICI) improves outcomes in stage III melanoma. Real-world data remain limited, especially in patient subgroups ineligible for trials or undergoing approaches deviating from trial protocols. METHODS: Retrospective review of all patients who received nICI outside clinical trials for resectable stage IIIB-D melanoma across 8 Australian institutions. Baseline characteristics, treatment details, radiological and pathological responses, event-free survival (EFS) and recurrence-free survival (RFS) were examined. RESULTS: From June 2023 to October 2025, 268 patients received nICI; 173 (65%) had lymph node (LN) metastases only, 65 (24%) had in-transit metastases (ITM) only, and 30 (11%) had both. Anti-PD-1 monotherapy (mono) was used in 198 patients (74%); 70 (26%) received anti-PD- + anti-CTLA-4 (combo). Surgery was performed in 227 patients (85%), while 41 (15%) did not proceed to surgery: 25 following clinical complete response (cCR), 14 due to progression, and 2 due to toxicity. Major pathological response (MPR) was achieved in 118 patients (52%). At a median follow-up of 12.1 months, combo was associated with higher 12-month EFS than mono (85.6% vs 75.6%, p < 0.05). Patients with MPR to mono who omitted adjuvant ICI had lower 12-month RFS than those who received it (80.4% vs 100%, p < 0.05); this difference was not observed after MPR to combo. ITM-only patients had similar 12-month EFS to LN-only patients (76.2% vs 81.0%, p = 0.13). No patient managed nonoperatively after cCR recurred. CONCLUSION: Neoadjuvant ICI is feasible in real-world practice, including for ITM-only disease. Following MPR to mono, adjuvant ICI confers superior outcomes than omitting it.
- Publisher
- Elsevier
- Keywords
- Adjuvant; Immune checkpoint inhibitors; Immunotherapy; In-transit metastases; Melanoma; Neoadjuvant; Nonoperative management; Real-world
- Department(s)
- Surgical Oncology; Medical Oncology
- Publisher's Version
- https://doi.org/10.1016/j.ejca.2026.116865
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2026-06-30 03:12:33
Last Modified: 2026-06-30 03:12:41