Highlights

There is a group of patients, and they could be primarily [Stage] IIIb, IIIc, or IIId, that have let’s say clinically detectable disease, or radiologically microscopic regional lymph node metastasis, or in trend of metastasis, based on the emergent data, and benefits from neoadjuvant systemic therapy. This is becoming more and more part of my practice as well as nationally at the major centers, even based on data from studies, as well that these options are often available through clinical trials, I’m more and more utilizing neoadjuvant systemic therapy. The advantage here is that a tumor may well respond well upfront before surgery, reducing let’s say the morbidity of the surgery, and potentially improving the outcome of surgery as well as the outcome of the patient overall. So, these patients would be offered systemic adjuvant therapy if they present to us following surgery, or if they are candidates for systemic neoadjuvant therapy, they would be offered the option of systemic therapy either as the standard of care or in clinical trials.

Those who had received let’s say anti-PD-1 monotherapy, let’s say Keytruda or Opdivo, our treatment of choice is continuing with immunotherapy for as long as we can in the absence of strict indications to salvage them quickly let’s say with BRAF-MEK inhibitors if we have a BRAF mutation. So, if patients receive anti-PD-1 monotherapy, then as a standard of care and here outside of clinical trials, […] the second line would be the combination of Yervoy and Opdivo primarily. A potential similar option could be Keytruda + Yervoy as well if they started with anti-PD-1 monotherapy.