Emerging Indications for Neoadjuvant Systemic Therapies in Cutaneous Malignancies

• Published in: Medical sciences (Basel) Vol. 12; no. 3; p. 35
• Main Authors: Junior, Domingos Sávio do Rego Lins, Cidale, Beatriz Mendes Awni, Pereira, Ana Zelia Leal, de Menezes, Jacqueline Nunes, Bertolli, Eduardo, Belfort, Francisco Aparecido, Munhoz, Rodrigo Ramella
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 23.07.2024; MDPI
• Subjects: Adjuvants; basal cell carcinoma; Biomarkers; Biopsy; Cancer therapies; Carcinoma, Merkel Cell - therapy; Carcinoma, Squamous Cell - therapy; Dendritic cells; Humans; Immunotherapy; Medical prognosis; Melanoma; Melanoma - drug therapy; Melanoma - therapy; Merkel cell carcinoma; Metastasis; Mortality; Neoadjuvant Therapy; Review; Skin cancer; Skin Neoplasms - drug therapy; Squamous cell carcinoma; T cell receptors; Tumors; basal cell carcinoma; melanoma; Merkel cell carcinoma; neoadjuvant therapy; immunotherapy; squamous cell carcinoma
• ISSN: 2076-3271; 2076-3271
• DOI: 10.3390/medsci12030035

Patients with cutaneous malignancies and locoregional involvement represent a high-risk population for disease recurrence, even if they receive optimal surgery and adjuvant treatment. Here, we discuss how neoadjuvant therapy has the potential to offer significant advantages over adjuvant treatment, further improving outcomes in some patients with skin cancers, including melanoma, Merkel cell carcinoma, and cutaneous squamous-cell carcinoma. Both preclinical studies and in vivo trials have demonstrated that exposure to immunotherapy prior to surgical resection can trigger a broader and more robust immune response, resulting in increased tumor cell antigen presentation and improved targeting by immune cells, potentially resulting in superior outcomes. In addition, neoadjuvant approaches hold the possibility of providing a platform for evaluating pathological responses in the resected lesion, optimizing the prognosis and enabling personalized adaptive management, in addition to expedited drug development. However, more data are still needed to determine the ideal patient selection and the best treatment framework and to identify reliable biomarkers of treatment responses. Although there are ongoing questions regarding neoadjuvant treatment, current data support a paradigm shift toward considering neoadjuvant therapy as the standard approach for selecting patients with high-risk skin tumors.