Pooled melanoma analysis links neoadjuvant immunotherapy response to high five-year survival

An updated International Neoadjuvant Melanoma Consortium pooled analysis assessed long-term outcomes in 1,038 patients treated at 26 international sites. Patients received neoadjuvant immune checkpoint inhibitors (ICIs; n=735), BRAF/MEK inhibitors (n=119), or ICIs plus targeted therapy (n=184). Most were treated in trials (72.7%), with 27.3% treated outside trials. Endpoints included major pathological response (MPR), recurrence-free survival (RFS) and overall survival (OS).

MPR occurred in 57.8% of ICI recipients, 51.4% receiving BRAF/MEK inhibitors and 44.6% receiving ICIs plus targeted therapy. Anti-PD-1 combined with other immuno-oncology agents produced a higher MPR rate than anti-PD-1 alone (61.4% versus 49.5%). Five-year RFS was 61.0% with anti-PD-1 alone, 73.9% with combination immunotherapy, 37.4% with BRAF/MEK inhibitors and 76.4% with ICIs plus targeted therapy. Corresponding OS rates were 83.3%, 87.5%, 69.8% and 83.9%.

Among ICI-treated patients achieving MPR, five-year OS was 98.8% with anti-PD-1 alone and 97.9% with combination immunotherapy. The authors reported no benefit from continuing adjuvant ICIs in these responders. These findings support pathological response as an important prognostic marker, but pooled treatment comparisons do not establish causal superiority or justify routinely omitting adjuvant therapy. Subgroup sizes varied, and the available abstract does not provide uncertainty estimates or details needed to assess confounding.