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Is earlier better for melanoma checkpoint blockade?


A neoadjuvant approach relying on the administration of combined anti-CTLA-4–anti-PD-1 treatment before lymph node surgery is evaluated in two phase 1 trials. Encouraging clinical, pathological and immunological responses to neoadjuvant therapy were observed, suggesting that this concept warrants further exploration; however, any future approach must address the unacceptably high toxicity of the regimens evaluated in these trials.

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Fig. 1: Rationale for using neoadjuvant versus adjuvant immunotherapy in metastatic melanoma.

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  1. Robert, C. et al. N. Engl. J. Med. 372, 30–39 (2015).

    Article  Google Scholar 

  2. Robert, C. et al. N. Engl. J. Med. 372, 2521–2532 (2015).

    Article  CAS  Google Scholar 

  3. Robert, C. et al. N. Engl. J. Med. 372, 320–330 (2015).

    Article  CAS  Google Scholar 

  4. Robert, C. et al. J. Clin. Oncol. 36, 1668–1674 (2018).

    Article  CAS  Google Scholar 

  5. Wolchok, J. D. et al. N. Engl. J. Med. 369, 122–133 (2013).

    Article  CAS  Google Scholar 

  6. Eggermont, A. M. M. et al. N. Engl. J. Med. 378, 1789–1801 (2018).

    Article  CAS  Google Scholar 

  7. Weber, J. et al. N. Engl. J. Med. 377, 1824–1835 (2017).

    Article  CAS  Google Scholar 

  8. Amaria, R. N. et al. Nat. Med. (2018).

    Article  CAS  Google Scholar 

  9. Blank, C. et al. Nat. Med. (2018).

    Article  CAS  Google Scholar 

  10. Chen, Y. et al. Medicine (Baltimore) 97, e10634 (2018).

  11. MacLean, M. et al. Oncotarget 9, 24470–24479 (2018).

    Article  Google Scholar 

  12. Wolchok, J. D. et al. Clin. Cancer Res. 15, 7412–7420 (2009).

    Article  CAS  Google Scholar 

  13. Hodi, F. S. et al. J. Clin. Oncol. 34, 1510–1517 (2016).

    Article  CAS  Google Scholar 

  14. Liu, J. et al. Cancer Discov. 6, 1382–1399 (2016).

    Article  CAS  Google Scholar 

  15. Tetzlaff, M. T. et al. Ann. Oncol. 29, 1861–1868 (2018).

    Article  CAS  Google Scholar 

  16. Hellmann, M. D. et al. N. Engl. J. Med. 378, 2093–2104 (2018).

    Article  CAS  Google Scholar 

  17. Rizvi, N. A. et al. Science 348, 124–128 (2015).

    Article  CAS  Google Scholar 

  18. Long, G. V. et al. N. Engl. J. Med. 377, 1813–1823 (2017).

    Article  CAS  Google Scholar 

  19. Amaria, R. N. et al. Lancet Oncol. 19, 181–193 (2018).

    Article  CAS  Google Scholar 

  20. Gershenwald J. E. et al. CA Cancer J. Clin. 67, 472–492 (2017).

  21. Morton, D. L. et al. N. Engl. J. Med. 370, 599–609 (2014).

    Article  CAS  Google Scholar 

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Correspondence to Caroline Robert.

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Robert, C. Is earlier better for melanoma checkpoint blockade?. Nat Med 24, 1645–1648 (2018).

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