Surgery following systemic therapy against melanoma is a widely discussed topic in the world of clinical oncology. OncLive, a platform of information concerning cancers that include lung, leukemia, and melanoma, recently posted online a discussion amongst six expert panelists from cancer centers in the United States. The most recent discussion was episode 13 of a running discussion concerning the topic “Surgical Excision of Melanoma.”
The topic is unarguably relevant to a majority of patients with melanoma. According to Mario Sznol, MD, Yale, the overall response rate upon combination treatment of nivolumab and ipilimumab could actually be higher than reported, as a result of unconventional responses. In different clinical trials, this combination treatment successfully resulted in tumor regressions in all but one discordant lesion, leading oncologists to question if surgery could be utilized.
However, panelist Merrick I. Ross, MD, from MD Anderson Cancer Center, said that 85% of melanoma patients have clinically localized melanoma, making them prime candidates for surgical resection of tumors.
Following metastasectomies, patients with resectable stage IV melanoma see an average five-year survival rate of 40%, stated Robert H. I. Andtbacka, MD, CM, from University of Utah Huntsman Cancer Institute. However, metastasectomy is not the optimal treatment course for all patients. Patients with oligometastatic disease tend to fair better than others when treated with surgery.
Along the same lines, patients with lesser disease burden are potential candidates for surgery. To lessen disease burden, neoadjuvant treatments such as targeted or immuno-therapies can be administered prior to surgery. “Patients show a more durable response,” stated Jeffrey A. Sosman, MD, from Vanderbilt University, in the panel discussion video. Consequently, patients can be kept on therapy for longer.
One drawback of surgery following systemic melanoma treatment is the chance of removing regional nodes involved in immune activity. In this case, any immuno-therapies can be negatively impacted, and it is important to identify the correct therapies to be used in conjunction with surgery. To ascertain these data, clinical trials such as the phase 3 MSLT-II study are underway to determine if complete lymphadenectomy is appropriate for superior results.