Neoadjuvant BRAF‐targeted therapy in regionally advanced and oligometastatic melanoma

Zeynep Eroglu  Jennifer Eatrides  Syeda Mahrukh Hussnain Naqvi  Youngchul Kim  Jeani Rich  Nalan Akgul Babacan  Andrew S Brohl  Joseph Markowitz  Amod Sarnaik  Jonathan Zager … See all authors
First published: 22 July 2019 https://doi.org/10.1111/pcmr.12813
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/pcmr.12813
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Abstract
Background
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.

Methods
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 months 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.

Conclusion
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.