Neoadjuvant Immune Checkpoint Inhibitor Therapy in Melanoma: Efficacy, Safety and Timing

Reducing the positive margins rate for anal melanoma in the modern era: a national propensity score matched study

Anal Melanoma (AM) is a rare and aggressive disease lacking standardized treatment protocols. Despite advancements in medical oncology, the 5-year overall survival (OS) remains at 20%. Local surgery (LS) has gained popularity over radical surgery (RS) due to its comparable OS when negative margins are achieved. Neoadjuvant chemotherapy and radiotherapy do not improve margins status, while neoadjuvant immunotherapy (Neo-IT) has not been studied on AM margins status. Patients diagnosed with AM in the National Cancer Database (2011-2021) who received Neo-IT were retrospectively identified and divided into two cohorts based on the surgical approach (LS or RS). In each cohort, patients were matched in a 1:1 ratio to those who did not receive Neo-IT based on age and tumor size. Univariate analyses were performed to compare Neo-IT influence on surgical margins in both cohorts. Thirty patients were included in the LS cohort, with 56.7% of positive margins. Univariate analysis revealed that Neo-IT did not improve surgical margins in LS in AM (p value = 0.713). However, the 22 RS (31.8% positive margins) patient cohort's univariate analysis revealed that Neo-IT significantly improved surgical margins in AM (p value = 0.022). Achieving negative margins is crucial to increase OS in anal melanoma. Neo-IT appears to improve negative surgical margin status in RS for anal melanoma. However, Neo-IT did not improve margins in LS. This opportunity to improve margin suggests a potential to increase the 5-year OS of 20%. Future work is needed to determine the impact to OS and confirm the IT role in LS.

Perioperative therapy of melanoma: Adjuvant or neoadjuvant treatment

Surgery is the mainstay treatment of melanoma. However, even after radical resection the risk of relapses in majority of stage IIB-IV disease remains high. Currently, the standard treatment after surgery in high risk patients is systemic adjuvant therapy administered up to one year based on the results of clinical trials indicating significant reduction of risk of relapses. All clinical trials in adjuvant setting were based as primary end-point on relapse-free survival, not overall survival, and they did not incorporate and validate biomarkers prospectively. A new therapeutic strategy in locoregional advanced melanomas becomes a preoperative treatment to further increase of the cure rates and decrease the duration of systemic therapy.

Personalised Medicine and the Potential Role of Electrospinning for Targeted Immunotherapeutics in Head and Neck Cancer

Advanced head and neck cancer (HNC) is functionally and aesthetically destructive, and despite significant advances in therapy, overall survival is poor, financial toxicity is high, and treatment commonly exacerbates tissue damage. Although response and durability concerns remain, antibody-based immunotherapies have heralded a paradigm shift in systemic treatment. To overcome limitations associated with antibody-based immunotherapies, exploration into de novo and repurposed small molecule immunotherapies is expanding at a rapid rate. Small molecule immunotherapies also have the capacity for chelation to biodegradable, bioadherent, electrospun scaffolds. This article focuses on the novel concept of targeted, sustained release immunotherapies and their potential to improve outcomes in poorly accessible and risk for positive margin HNC cases.