[New therapeutic approaches in the neoadjuvant/adjuvant treatment of melanoma].

BACKGROUND

Although effective treatment options for malignant melanoma already exist, currently available adjuvant and neoadjuvant therapies are not always sufficient to prevent relapse or ensure a long-term treatment response. Many patients develop resistance or show inadequate responses to existing therapies. Therefore, there is an urgent need for new and more effective therapeutic approaches in the adjuvant and neoadjuvant settings to sustainably improve patient prognosis.

OBJECTIVE

This study provides an overview of current developments in melanoma treatment, with a particular focus on the adjuvant and neoadjuvant application of novel immunotherapies.

MATERIAL AND METHODS

A literature search and discussion of relevant recent studies was carried out.

RESULTS

Adjuvant mRNA-based adjuvant treatment combined with pembrolizumab demonstrated a significantly improved relapse-free survival compared to pembrolizumab monotherapy (79% vs. 62%). The value of adjuvant LAG‑3 antibodies in combination with PD‑1 blockers remains inconclusive. A neoadjuvant intralesional treatment with daromun after complete removal of tumor tissue reduced the risk of recurrence by 41% and led to a significant extension in relapse-free survival (16.7 months vs. 6.8 months). Tebentafusp improved overall survival in metastatic uveal melanoma and is currently being investigated in the adjuvant and neoadjuvant setting.

DISCUSSION

The mRNA-based treatment combined with checkpoint inhibitors have the potential to induce long-term immune responses. The efficacy of LAG-3 inhibitors in the adjuvant setting is currently under evaluation in clinical studies. The immunocytokine treatment with daromun shows promising results in the neoadjuvant setting by stimulating both local and systemic immune responses. Future studies should focus on identifying optimal combinations of treatment to improve the long-term prognosis of patients.