Neoadjuvant BRAF‐targeted therapy in regionally advanced and oligometastatic melanoma

• Published in: Pigment cell and melanoma research Vol. 33; no. 1; pp. 86 - 95
• Main Authors: Eroglu, Zeynep, Eatrides, Jennifer, Naqvi, Syeda Mahrukh Hussnain, Kim, Youngchul, Rich, Jeani, Babacan, Nalan Akgul, Brohl, Andrew S., Markowitz, Joseph, Sarnaik, Amod, Zager, Jonathan, Khushalani, Nikhil I., Sondak, Vernon K., Messina, Jane
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2020
• Subjects: Adult; Aged; BRAF‐targeted therapy; Disease-Free Survival; Female; Humans; Imidazoles - pharmacology; Imidazoles - therapeutic use; Male; Melanoma; Melanoma - diagnostic imaging; Melanoma - pathology; Melanoma - therapy; Metastasis; Middle Aged; Molecular Targeted Therapy; Morbidity; Neoadjuvant Therapy; Neoplasm Metastasis; Neoplasm Staging; Oximes - pharmacology; Oximes - therapeutic use; Patients; Proto-Oncogene Proteins B-raf - antagonists & inhibitors; Proto-Oncogene Proteins B-raf - metabolism; Pyridones - pharmacology; Pyridones - therapeutic use; Pyrimidinones - pharmacology; Pyrimidinones - therapeutic use; Surgery; Therapy; Treatment Outcome; Tumors; BRAF-targeted therapy; melanoma; neoadjuvant therapy
• ISSN: 1755-1471; 1755-148X
• DOI: 10.1111/pcmr.12813

Current management of locoregional and oligometastatic melanoma is typically with surgery; however, some patients are unable to undergo resection due to location/size of their tumors and/or the anticipated morbidity of the surgery. While there are currently no established guidelines for neoadjuvant therapy in melanoma, neoadjuvant BRAF‐targeted therapy may make resection more feasible. A retrospective analysis was conducted of 23 patients with BRAFV600‐mutant, stage III/IV melanoma treated with BRAF‐targeted therapy prior to surgery, with no adjuvant treatment. Surgical specimens, preoperative imaging, and clinical outcomes were evaluated. Results: Ten of 23 patients (44%) attained a pathologic complete response (pCR), with no correlation between RECIST response based on preoperative imaging and pathologic response. After a median of 43‐month follow‐up, only 1 patient (10%) with a pCR recurred, while 8 of 13 (62%) patients without a pCR recurred. Patients with a pCR had significantly improved relapse‐free (RFS) and overall survival (OS) compared to patients with residual tumor. Neoadjuvant BRAF‐targeted therapy is associated with a high pCR rate in patients with stage III‐IV melanoma, which may correlate with improved RFS and OS.