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Resident's Forum
RF – Neoadjuvant Therapy in Melanoma
FR – Neoadyuvancia en melanoma
A. Arrietaa,b,
Corresponding author
, M. Blanco de Torda,b, A. Boadaa,b,c
a Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
b Institut d’Investigació Germans Trias i Pujol, Badalona, Barcelona, Spain
c Universitat Autònoma de Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Neoadjuvant therapy refers to the use of systemic anticancer drugs prior to surgery&#46; The goal is the same as that of adjuvant therapy&#58; to treat undetected locoregional or distant metastasis&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> While neoadjuvant treatment regimens have been standardized in certain stages of breast&#44; lung&#44; and rectal cancer&#44; they are still under investigation in melanoma&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The ideal candidates for neoadjuvant therapy in melanoma are patients with nodal disease detected by clinical or ultrasound examination &#40;stage IIIB&#44; IIIC&#44; or IIID disease according to the eighth edition of the American Joint Committee on Cancer Staging Manual&#41; or resectable oligometastatic disease &#40;stage IV&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Most studies of neoadjuvant therapy in melanoma have investigated immunotherapeutic agents&#44; although some have focused on targeted therapies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main advantage of neoadjuvant therapy is that it enables the early treatment of microscopic distant disease&#44; while in many cases also reducing the volume of lymph node disease and hence decreasing surgical morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Histologic evaluation of resected tumor specimens from patients who have received neoadjuvant therapy helps determine pathologic responses and potential treatment benefits&#46; The resulting information can also be used to individualize future treatment schedules and durations&#46; A greater understanding of pathologic responses may also enable modifications to current surgical techniques&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The advent of neoadjuvant therapy has given oncologists the possibility of using conservative lymph node surgery instead of complete lymph node dissection &#40;CLND&#41; in patients with complete pathologic response in the lymph node harboring the metastasis &#40;the index node&#41;&#46; Two notable studies in this regard are MeMaLoc<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and PRADO&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> in which patients with clinically or ultrasound-detected stage III melanoma and lymph node metastasis were started on immunotherapy prior to surgery&#46; Just a few weeks after initiation of treatment&#44; the index node was marked with a magnetic &#40;MeMaLoc&#41; or radioactive &#40;PRADO&#41; seed&#46; After 6 weeks of immunotherapy&#44; the 12 patients in the MeMaLoc study underwent CLND&#46; In all cases&#44; pathologic index node responses were congruent with responses in the rest of the nodes&#46; Patients with a complete or near-complete pathologic response in the index node had no metastases in the rest of the basin&#46; The PRADO study went a step further and stratified patients by pathologic response after removal and examination of the index node to identify candidates for CLND&#46; Of the 99 patients studied&#44; 59 achieved a pathologic response of more than 90&#37; and did not undergo CLND&#46; The remaining 40 patients underwent CLND&#44; and those with more than 50&#37; viable tumor continued treatment with immunotherapy or targeted therapy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The risks of neoadjuvant therapy include rendering a patient who does not respond to treatment inoperable due to tumor progression or general worsening of their condition due to toxicity&#46; Adequate selection of patients who could benefit from neoadjuvant therapy in the setting of melanoma will therefore be crucial in the near future&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">Aranzazu Arrieta and Mar&#237;a Blanco de Tord declare no conflicts of interest&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Aram Boada has received fees from or participated in clinical trials sponsored by Novartis&#44; Roche&#44; Pierre-Fabre&#44; BMS&#44; and MSD&#46;</p></span></span>"
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Article information
ISSN: 00017310
Original language: English
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Year/Month Html Pdf Total
2024 November 13 13 26
2024 October 110 51 161
2024 September 91 32 123
2024 August 111 70 181
2024 July 72 38 110
2024 June 79 43 122
2024 May 64 34 98
2024 April 63 33 96
2024 March 53 40 93
2024 February 45 27 72
2024 January 34 23 57
2023 December 38 14 52
2023 November 46 27 73
2023 October 47 28 75
2023 September 41 23 64
2023 August 51 23 74
2023 July 59 31 90
2023 June 61 18 79
2023 May 37 29 66
2023 April 68 26 94
2023 March 144 60 204
2023 February 56 75 131
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Idiomas
Actas Dermo-Sifiliográficas
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?