Abstract
Neoadjuvant therapy is an under-utilized regimen for the treatment of metastatic melanoma. The use of this approach has been increasing in other tumor types. Neoadjuvant therapy may reduce occult circulating tumor cell burden in the face of bulky disease and afford a real time evaluation of treatment effectiveness. Neoadjuvant approach can also provide preoperative histologic and molecular analysis of treated tissue that may guide the postoperative treatment planning in patients with resectable metastatic melanoma lesions. The putative benefits of better margin control and clearance of occult systemic disease would theoretically improve surgical outcome. With the advent of effective agents against metastatic melanoma, this common approach to the treatment of rectal cancer, metastatic colon cancer, and breast cancer should also be evaluated as a viable treatment strategy for advanced stage melanoma.
Highlights
Malignant melanoma is a highly curable cancer when detected early but often fatal at advanced stage
Neoadjuvant approach is historically under-utilized in the treatment of metastatic melanoma in comparison to other tumor types mainly due to the ineffectiveness of systemic therapy
The promising results of biochemotherapy neoadjuvant trials and the emergence of active agents in melanoma suggested that this approach would shed light on the rational selection of optimal treatment for metastatic melanoma patients
Summary
Malignant melanoma is a highly curable cancer when detected early but often fatal at advanced stage. Shah et al reported their phase II neoadjuvant temozolomide trial in resectable stage III and IV patients [7,16]. In a neoadjuvant study with 64 stage III melanoma patients, Buzaid et al reported a histologic response rate of 50% [8].
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