Moderator of the press conference at the 2023 International Conference on Surgical Cancer Care, Callisia N. Clarke, MD, MS, FACS, FSSO, Assistant Professor of Surgery at the Medical College of Wisconsin, highlighted the significance of the 80% response rates to neoadjuvant immunotherapy in primary desmoplastic melanoma, referring to the results as “fantastic.”

Callisia N. Clarke, MD, MS, FACS, FSSO

Dr. Clarke noted her interest in determining whether radiographic responses could help identify patients who may need resection or potentially skip it. She asked Dr. Vernon Sondak the following questions: “Did you see a clinical response in these patients, or was there a corresponding radiographic response? Could that help us to determine which patients may potentially need resection once we validate this more, or do we potentially skip resection in patients who have complete radiologic responses?”

“In general with neoadjuvant therapy for melanoma, the pathologic response can be much more robust than what we see clinically,” Dr. Sondak responded. “Sometimes, we’ll see minor shrinkage [radiographically] and then find the tumor is totally necrotic [during resection]. But with desmoplastic melanoma, we’re more likely to see clinical regression quickly, and when we do the pathologic results are usually excellent as well.” He further noted the possibility of de-escalating treatment, as radiation therapy was not used as frequently in these patients as would be expected with standard-of-care management. However, he acknowledged a trade-off between 5 weeks of radiation therapy vs 9 weeks of immunotherapy. “I’m not sure which of those is easier or harder [to tolerate],” he added.

Finally, regarding the impact of immunotherapy on patient outcomes, Dr. Sondak underscored the need for further evaluation of this treatment strategy to confirm and build upon these findings. “Until we know that this truly changes outcomes, it’s a debate of which modality to use. However, if we know these patients are doing better because they received immunotherapy, then that reframes the debate and will change how patients with desmoplastic melanoma are managed,” he concluded. 

DISCLOSURE: Dr. Clarke reported no conflicts of interest.