Join the Behind the Knife Surgical Oncology Team as we discuss the PRADO and NADINA randomized control trials regarding neoadjuvant therapy in Stage III melanoma with macroscopic nodal disease!

Hosts:

Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.

Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 2ndYear Surgical Oncology fellow at MD Anderson.

Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a General Surgery physician in the United States Air Force station at RAF Lakenheath.

Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.

Galen Gist, MD (@gistgalen) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.

 Learning Objectives:

-       Evaluate the role of Completion Lymph Node Dissection (CLND) in patients with positive sentinel lymph nodes, specifically citing the lack of melanoma-specific survival benefit vs. the improvement in regional disease control demonstrated in the MSLT-II trial.

-       Determine the appropriate surgical excision margins for primary cutaneous melanoma, comparing the outcomes of 1 cm versus 2 cm margins as analyzed in the MINT trial (Lancet 2019).

-       Analyze the impact of adjuvant systemic therapy (Anti-PD1/Immunotherapy) on recurrence-free survival in patients with resected high-risk Stage III melanoma.

References:

Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x

Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2

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