Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida.
Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida.
Pigment Cell Melanoma Res. 2020 Jan;33(1):86-95. doi: 10.1111/pcmr.12813. Epub 2019 Sep 12.
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.
目前，局部区域性和寡转移性黑色素瘤的治疗方法通常是手术；然而，由于肿瘤的位置/大小和/或手术的预期发病率，有些患者无法进行切除。虽然目前黑色素瘤的新辅助治疗尚无既定指南，但新辅助 BRAF 靶向治疗可能使切除更可行。对 23 例接受 BRAF 靶向治疗（术前）的 BRAFV600 突变、III/IV 期黑色素瘤患者进行了回顾性分析，未接受辅助治疗。评估了手术标本、术前影像学和临床结果。结果：23 例患者中有 10 例（44%）达到了病理完全缓解（pCR），术前影像学上的 RECIST 反应与病理反应之间没有相关性。中位随访 43 个月后，仅 1 例（10%）pCR 患者复发，而 13 例（62%）未达 pCR 的患者中有 8 例复发。与残留肿瘤患者相比，pCR 患者的无复发生存（RFS）和总生存（OS）显著改善。新辅助 BRAF 靶向治疗与 III/IV 期黑色素瘤患者的高 pCR 率相关，这可能与 RFS 和 OS 的改善相关。
