In exploratory analyses of results from the SWOG S1801 trial in patients with stage III-IV resectable melanoma, researchers saw a major pathologic response in more than half of surgical specimens taken from patients who had been treated with neoadjuvant (pre-operative) pembrolizumab.
These and other results of the analyses are presented as a proffered paper at the European Society of Medical Oncology Congress 2023 in Madrid, Spain, on Monday, October 23, by Sapna P. Patel, MD, chair of the SWOG melanoma committee and associate professor of melanoma medical oncology at the University of Texas MD Anderson Cancer Center. Patel is principal investigator of the S1801 trial.
"But it is important not to over-interpret the results. The absence of a pathologic response means there is room for improvement, but those patients still likely benefitted from a neoadjuvant approach with immunotherapy where their immune system began priming with tumor in situ than if they had gone to upfront surgery. The goal of a short duration of neoadjuvant immunotherapy is to initiate tumor priming, not necessarily to shrink the tumor or demonstrate pathologic response.
To assess pathologic response to a treatment, a pathologist examines tissue removed during surgery to see whether it includes any actively growing cancer cells – known as residual viable tumor. If no active cells are seen, the tissue is said to have undergone a pathologic complete response to treatment. If active cancer cells comprise only 1 percent to 10 percent of the tumor bed, it is said to have undergone a pathologic near-complete response.
A total of 135 patients in S1801 who received neoadjuvant pembrolizumab subsequently underwent surgery. From these patients, 105 specimens were submitted for central review for pathologic response; the vast majority of these were lymph node specimens. All reviews were performed by Victor G. Prieto, MD, PhD, the Ferenc and Phyllis Gyorkey Chair for Research and Education in Pathology at the University of Texas MD Anderson Cancer Center.
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Major pathologic response to neoadjuvant pembrolizumab in advanced melanoma trial exceeds 50%In exploratory analyses of results from the SWOG S1801 trial in patients with stage III-IV resectable melanoma, researchers saw a major pathologic response in more than half of surgical specimens taken from patients who had been treated with neoadjuvant (pre-operative) pembrolizumab.
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