Oncology Center, Hospital Sírio-Libanês, São Paulo 01308-050, Brazil.
Cutaneous Malignancies and Sarcoma Group, Hospital Sírio-Libanês, São Paulo 01308-050, Brazil.
Med Sci (Basel). 2024 Jul 23;12(3):35. doi: 10.3390/medsci12030035.
Patients with cutaneous malignancies and locoregional involvement represent a high-risk population for disease recurrence, even if they receive optimal surgery and adjuvant treatment. Here, we discuss how neoadjuvant therapy has the potential to offer significant advantages over adjuvant treatment, further improving outcomes in some patients with skin cancers, including melanoma, Merkel cell carcinoma, and cutaneous squamous-cell carcinoma. Both preclinical studies and in vivo trials have demonstrated that exposure to immunotherapy prior to surgical resection can trigger a broader and more robust immune response, resulting in increased tumor cell antigen presentation and improved targeting by immune cells, potentially resulting in superior outcomes. In addition, neoadjuvant approaches hold the possibility of providing a platform for evaluating pathological responses in the resected lesion, optimizing the prognosis and enabling personalized adaptive management, in addition to expedited drug development. However, more data are still needed to determine the ideal patient selection and the best treatment framework and to identify reliable biomarkers of treatment responses. Although there are ongoing questions regarding neoadjuvant treatment, current data support a paradigm shift toward considering neoadjuvant therapy as the standard approach for selecting patients with high-risk skin tumors.
患有皮肤恶性肿瘤和局部区域受累的患者即使接受了最佳的手术和辅助治疗，也代表着疾病复发的高风险人群。在这里，我们讨论了新辅助治疗有可能比辅助治疗提供显著优势，进一步改善某些皮肤癌患者（包括黑色素瘤、默克尔细胞癌和皮肤鳞状细胞癌）的预后。临床前研究和体内试验都表明，在手术切除前接受免疫治疗可以触发更广泛和更强的免疫反应，导致肿瘤细胞抗原呈递增加，并改善免疫细胞的靶向性，从而可能获得更好的结果。此外，新辅助方法有可能为评估切除病变的病理反应提供一个平台，优化预后，并实现个性化的适应性管理，以及加快药物开发。然而，仍需要更多的数据来确定理想的患者选择和最佳的治疗框架，并确定治疗反应的可靠生物标志物。尽管对新辅助治疗仍存在一些疑问，但目前的数据支持向将新辅助治疗作为选择高危皮肤肿瘤患者的标准方法的范式转变。
