A Systematic Review and Meta-Analysis of Surgical Feasibility and Outcomes Following Neoadjuvant Immune Checkpoint Inhibition in Resectable Stage III and IV Melanoma.

In 30 seconds

This systematic review and random-effects meta-analysis assessed oncologic and perioperative outcomes after neoadjuvant immune checkpoint inhibition (ICI) followed by planned curative-intent surgery in adults with resectable stage III or oligometastatic stage IV melanoma. Across 20 prospective and retrospective studies comprising 1384 patients, pooled pathological complete response was 0.33 (CI 0.26-0.40), and failure or delay to surgery occurred in 0.09 (CI 0.07-0.12). Major perioperative complications were reported in 0.08 (CI 0.05-0.13), while major treatment-related toxicities occurred in 0.25 (CI 0.18-0.34).

Key findings

• Pooled pathological complete response was 0.33 (CI 0.26-0.40); overall pathological response was 0.59 (CI 0.51-0.67).
• Failure or delay to surgery occurred in 0.09 (CI 0.07-0.12), including disease progression during neoadjuvant therapy in 0.06 (CI 0.04-0.10).
• Major perioperative complications occurred in 0.08 (CI 0.05-0.13), compared with major treatment-related toxicities in 0.25 (CI 0.18-0.34).
• Comparative analyses found similar perioperative complication rates between neoadjuvant and adjuvant approaches, with lower recurrence risk favoring neoadjuvant therapy (p < 0.01).

Why it matters

The findings suggest that neoadjuvant ICI can produce substantial pathological responses without commonly preventing or delaying planned surgery, while highlighting that serious systemic toxicity is more frequent than major operative complications. These pooled estimates help frame the balance of oncologic response, surgical feasibility, and treatment harms when considering this approach for resectable stage III and selected stage IV melanoma.

What to keep in mind

The review included both prospective and retrospective studies, and perioperative reporting was heterogeneous, as noted by the authors.