# Neoadjuvant immunotherapy → response-adapted adjuvant

Source: https://onco.cc/pairings/neoadjuvant-io-response-adapted/  
OnCo record `neoadjuvant-io-response-adapted` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Treat before surgery, look at the removed tumour, and only continue treatment if the response was incomplete.

## Summary

This sequence gives immune checkpoint inhibitors before surgery in melanoma, examines the removed tumour and lymph nodes, and continues adjuvant therapy only when the pathological response was incomplete. The intact tumour and nodes supply antigen and T-cell priming, and pathological response is a reliable early read-out that allows treatment to be de-escalated. The phase 3 NADINA trial used two neoadjuvant cycles of nivolumab and ipilimumab, then surgery, then adjuvant therapy only for partial or non-responders, and most patients were spared a year of adjuvant treatment. The phase 2 SWOG S1801 trial showed that pembrolizumab works better when part of the course is given before surgery. The design feeds the idea of pre-surgery platform trials judged on pathological response.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: Immune checkpoint inhibitors + Sentinel lymph node biopsy
- Type: sequence
- Rationale: The intact tumour and nodes provide antigen and T-cell priming; pathological response is a reliable early readout that lets therapy be de-escalated.
- Evidence: Phase 3 NADINA, phase 2 SWOG S1801.

## Sources

- ClinicalTrials.gov NCT04949113: NADINA: https://clinicaltrials.gov/study/NCT04949113
- ClinicalTrials.gov NCT03698019: SWOG S1801: https://clinicaltrials.gov/study/NCT03698019

## Connected records

- cancers: [Melanoma](https://onco.cc/cancers/melanoma/)
- drugs: [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- terms: [Major pathological response (MPR)](https://onco.cc/terms/major-pathological-response/)
- trials: [NADINA](https://onco.cc/trials/nadina/), [SWOG S1801](https://onco.cc/trials/swog-s1801/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/)
- ideas: [Pre-surgery platform trials that test combinations on pathological response in months](https://onco.cc/ideas/idea-tr2-neoadjuvant-combo-platform/)

---
JSON: https://onco.cc/api/v1/entities/neoadjuvant-io-response-adapted.json