期刊
ANNALS OF ONCOLOGY
卷 29, 期 8, 页码 1861-1868出版社
OXFORD UNIV PRESS
DOI: 10.1093/annonc/mdy226
关键词
melanoma; neoadjuvant therapy; targeted therapy; immune checkpoint blockade; pathology
类别
资金
- University of Texas MD Anderson Cancer Center Melanoma Moon Shots Program
- Melanoma Research Alliance
- Harry J. Lloyd Trust
- National Cancer Institute [R01 CA142779]
- Bloomberg-Kimmel Institute for Cancer Immunotherapy
- Australian National Health and Medical Research Council Practitioner Fellowship program
- T32 training grant [NIH T32 CA193145]
Background: Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment. Methods: The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines. Results: Based on our collective experience and guided by efforts in well-established neoadjuvant settings like breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy-treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated. Conclusions: Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.
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