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Most stage II patients never relapse, yet all are offered a year of immunotherapy. Use a blood test to treat only those with detectable residual disease.
The idea is to reserve adjuvant PD-1 therapy in stage II to III melanoma for patients with detectable residual disease on a tumour-informed ctDNA assay, or to start it when ctDNA appears, instead of treating everyone. KEYNOTE-716 and CheckMate 76K treat all stage IIB and IIC patients for a modest absolute benefit although most never relapse, so over-treatment and immune toxicity are substantial. Melanoma sheds ctDNA in proportion to burden, and IMvigor011 proved the concept of ctDNA-triggered adjuvant immunotherapy in bladder cancer. The hypothesis is equivalent distant metastasis-free survival with far fewer patients treated; the test is the UK DETECTION design of ctDNA-triggered versus standard adjuvant pembrolizumab, addressing the dormancy bottleneck.
Shares KEYNOTE-716, Stage IIB and IIC melanoma, Melanoma, Immune checkpoint inhibitors.
Shares KEYNOTE-716, Stage IIB and IIC melanoma.
Shares Stage IIB and IIC melanoma, Stage III melanoma (after surgery), Melanoma.
Shares Stage IIB and IIC melanoma, Stage III melanoma (after surgery), Melanoma.
Shares Stage IIB and IIC melanoma, Stage III melanoma (after surgery), Melanoma.
Shares IMvigor011, Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD), MRD / molecular residual disease testing.
Shares Stage IIB and IIC melanoma, BRAF V600-mutant melanoma, Melanoma.
Shares Dormant cells and minimal residual disease, Minimal / molecular residual disease (MRD), MRD / molecular residual disease testing.