Standard neoadjuvant immunotherapy in patients with resectable stage III melanoma – The early Australian experience
Author Identifier (ORCID)
Abstract
Background: Neoadjuvant immune checkpoint inhibitor therapy (nICI) improves outcomes in stage III melanoma. Real-world data remain limited, especially in patient subgroups ineligible for trials or undergoing approaches deviating from trial protocols. Methods: Retrospective review of all patients who received nICI outside clinical trials for resectable stage IIIB-D melanoma across 8 Australian institutions. Baseline characteristics, treatment details, radiological and pathological responses, event-free survival (EFS) and recurrence-free survival (RFS) were examined. Results: From June 2023 to October 2025, 268 patients received nICI; 173 (65%) had lymph node (LN) metastases only, 65 (24%) had in-transit metastases (ITM) only, and 30 (11%) had both. Anti-PD-1 monotherapy (mono) was used in 198 patients (74%); 70 (26%) received anti-PD-1 + anti-CTLA-4 (combo). Surgery was performed in 227 patients (85%), while 41 (15%) did not proceed to surgery: 25 following clinical complete response (cCR), 14 due to progression, and 2 due to toxicity. Major pathological response (MPR) was achieved in 118 patients (52%). At a median follow-up of 12.1 months, combo was associated with higher 12-month EFS than mono (85.6% vs 75.6%, p ' 0.05). Patients with MPR to mono who omitted adjuvant ICI had lower 12-month RFS than those who received it (80.4% vs 100%, p ' 0.05); this difference was not observed after MPR to combo. ITM-only patients had similar 12-month EFS to LN-only patients (76.2% vs 81.0%, p = 0.13). No patient managed nonoperatively after cCR recurred. Conclusion: Neoadjuvant ICI is feasible in real-world practice, including for ITM-only disease. Following MPR to mono, adjuvant ICI confers superior outcomes than omitting it.
Keywords
adjuvant, immune checkpoint inhibitors, immunotherapy, in-transit metastases, gelanoma, neoadjuvant, nonoperative management, real-world
Document Type
Journal Article
Date of Publication
7-26-2026
Article Number
116865
ISSN
09598049
Volume
243
Publication Title
European Journal of Cancer
Publisher
Elsevier
School
Centre for Precision Health
RAS ID
99996
Funding Information
AMM is supported by an NHMRC Investigator Grant and Nicholas and Helen Moore. SNL have received funding from Melanoma Institute Australia. GVL is supported by an NHMRC Investigator Grant.
Copyright
subscription content
Content Type
Metadata only
Recommended Citation
Proulx-Rocray, F., Symons, R., Wang, Y., Liaqat, S., Warburton, L., Jiang, C., Wong, T., Hsiao, E., Ch’ng, S., Shannon, K. F., Rtshiladze, M., Pennington, T. E., Coker, D. J., Carlino, M. S., Spillane, A., Stretch, J., Saw, R. P., Van Akkooi, A. C., Snow, H., . . . Menzies, A. M. (2026). Standard neoadjuvant immunotherapy in patients with resectable stage III melanoma – The early Australian experience. European Journal of Cancer, 243, Article 116865. https://doi.org/10.1016/j.ejca.2026.116865