ESMO 2025 | The benefits of neoadjuvant dual checkpoint inhibition in stage III melanoma
Minke Lucas, MD, Netherlands Cancer Institute, Amsterdam, Netherlands, comments on the benefits of neoadjuvant treatment, highlighting improved efficacy as the main reason, and notes that the neoadjuvant setting is superior to the adjuvant setting due to the presence of more neoantigens, inducing a stronger and more diverse T-cell response against the tumor. Additional benefits include a quick readout of treatment efficacy through correlation between pathological responses and patient outcomes, as seen in the NADINA trial (NCT04949113). This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
I think that very important, of course, is improved efficacy, the main reason. And we did see that in NADINA, but we also saw that in other neoadjuvant trials. An important one also is the SWOG S1801 trial that showed the same with neoadjuvant pembrolizumab followed by adjuvant pembrolizumab versus adjuvant pembrolizumab alone. So really the neoadjuvant setting is better than the adjuvant setting because you have probably more neoantigens in the setting that you are providing the immune checkpoint blockade...
I think that very important, of course, is improved efficacy, the main reason. And we did see that in NADINA, but we also saw that in other neoadjuvant trials. An important one also is the SWOG S1801 trial that showed the same with neoadjuvant pembrolizumab followed by adjuvant pembrolizumab versus adjuvant pembrolizumab alone. So really the neoadjuvant setting is better than the adjuvant setting because you have probably more neoantigens in the setting that you are providing the immune checkpoint blockade. And that is inducing a stronger and more diverse T-cell response against the tumor. But there are also other benefits. For example, that you have a very quick readout of the efficacy of your treatment because we do see a correlation between pathological responses and the category of your pathological response. For example, pCR patients have excellent EFS and DMFS at two years in our study. And with that, we can probably have a very quick readout of the efficacy of your treatment. And that will also inform further personalization of, for example, the adjuvant treatment, which was exactly what we also did in the ADINA trial, in which we only gave patients with a partial and non-response the adjuvant treatment.
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