Neoadjuvant versus Adjuvant Therapy for Stage IIIB-IIID Melanoma

The treatment landscape for advanced stage melanoma is rapidly evolving due to advancements in our understanding of melanoma biology and the emergence of novel therapies. This necessitates a comprehensive review to guide clinicians in adopting evidence based and patient centric approaches to treat stage IIIB-IIID melanoma. A literature review was conducted to synthesize current information on the most optimal treatment available. Data available from different clinical trials found that neoadjuvant therapy was a more effective treatment compared to adjuvant therapies alone. Furthermore, neoadjuvant therapy with combination therapy was more efficacious in producing a complete pathological response compared to monotherapy. A follow-up study on patients treated with neoadjuvant therapy with PD1 inhibitor pembrolizumab found that patients who produced a major pathologic response (MPR) or complete response (pCR) had higher 5 year Overall Survival rates. The trial highlights the importance of tailoring pharmacological treatment to patients to receive a significant pathological response. In addition, finding robust biomarkers is important in assessing therapies to personalize them to the patient. Longer term follow-up should be emphasized due to observed differences in median time to recurrence.