Usage of pembrolizumab before and after tumor resection surgery in patients with melanoma
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on March 6th, 2023
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Pembrolizumab is an antibody that can bind to PD-1 and lead to an antitumor response. The agent had been used as an adjuvant after tumor resection surgery to eliminate any remaining cancerous cells. As PD-1 inactivates antitumor T-cell, it might also be beneficial to provide pembrolizumab as a neoadjuvant before surgery. A study comparing the effectiveness of using the neoadjuvant plus adjuvant combination to just using adjuvant.
The phase 2 clinical trial included 313 participants who have experienced stage IIIb to IVc melanoma. These tumors have a minimum diameter of 1.5 cm and they are resectable with surgery. These patients have an average age of 63 years old and they were assigned to two different treatment groups: 1) neoadjuvant with adjuvant, and 2) only adjuvant. The standard adjuvant-only group was given 200 mg of pembrolizumab intravenously every 3 weeks for a total of 18 doses after their surgery to remove the melanoma tumor. The new treatment regimen also included 18 doses; 3 neoadjuvant doses of 200 mg was administered intravenously every 3 weeks before their surgery. Afterward, the remaining 15 doses of 200 mg were given intravenously every 3 weeks as an adjuvant after surgery. After 2 years, disease progression only happened in 28% of those in the neoadjuvant-adjuvant treatment group; whereas, the rate of disease progression is 51% in the adjuvant-only group. Thus, using pembrolizumab both before and after surgery is more beneficial than using only pembrolizumab post surgery. Since the number of pembrolizumab doses given were similar between the two groups, there was no significant difference in the adverse events between the neoadjuvant-adjuvant and adjuvant-only groups.
The phase 2 clinical trial included 313 participants who have experienced stage IIIb to IVc melanoma. These tumors have a minimum diameter of 1.5 cm and they are resectable with surgery. These patients have an average age of 63 years old and they were assigned to two different treatment groups: 1) neoadjuvant with adjuvant, and 2) only adjuvant. The standard adjuvant-only group was given 200 mg of pembrolizumab intravenously every 3 weeks for a total of 18 doses after their surgery to remove the melanoma tumor. The new treatment regimen also included 18 doses; 3 neoadjuvant doses of 200 mg was administered intravenously every 3 weeks before their surgery. Afterward, the remaining 15 doses of 200 mg were given intravenously every 3 weeks as an adjuvant after surgery. After 2 years, disease progression only happened in 28% of those in the neoadjuvant-adjuvant treatment group; whereas, the rate of disease progression is 51% in the adjuvant-only group. Thus, using pembrolizumab both before and after surgery is more beneficial than using only pembrolizumab post surgery. Since the number of pembrolizumab doses given were similar between the two groups, there was no significant difference in the adverse events between the neoadjuvant-adjuvant and adjuvant-only groups.