57: Neoadjuvant Pembrolizumab in Stage II-III Desmoplastic Melanoma (SWOG S1512): Surgical Considerations

Friday, March 24, 2023

10:24 AM – 10:34 AM

Location: Veterans Memorial Auditorium

Abstract Presenter(s)

Vernon K. Sondak, MD (he/him/his)

Chair, Department of Cutaneous Oncology
Moffitt Cancer Center
Tampa, Florida, United States

Disclosure(s): Alkermes: Independent Contractor (Ongoing); AmLO Biosciences: Advisor (Ongoing), Consultant (Ongoing); Bristol-Myers Squibb: Advisor (Ongoing), Consultant (Ongoing); Genesis Drug Discovery & Development: Independent Contractor (Ongoing); Iovance Biotherapeutics: Advisor (Ongoing), Consultant (Ongoing); Merck & Co., Inc.: Advisor (Ongoing), Consultant (Ongoing); Neogene Therapeutics: Research Grant (Ongoing); Novartis Pharmaceuticals Corporation: Advisor (Ongoing), Independent Contractor (Ongoing); Regeneron: Advisor (Ongoing), Consultant (Ongoing); SkylineDx: Research Grant (Ongoing); Turnstone Biologics: Contracted Research (Ongoing), Research Grant (Ongoing); Ultimovacs: Consultant (Ongoing)

First Author(s)

Vernon K. Sondak, MD (he/him/his)

Chair, Department of Cutaneous Oncology
Moffitt Cancer Center
Tampa, Florida, United States

Disclosure(s): Alkermes: Independent Contractor (Ongoing); AmLO Biosciences: Advisor (Ongoing), Consultant (Ongoing); Bristol-Myers Squibb: Advisor (Ongoing), Consultant (Ongoing); Genesis Drug Discovery & Development: Independent Contractor (Ongoing); Iovance Biotherapeutics: Advisor (Ongoing), Consultant (Ongoing); Merck & Co., Inc.: Advisor (Ongoing), Consultant (Ongoing); Neogene Therapeutics: Research Grant (Ongoing); Novartis Pharmaceuticals Corporation: Advisor (Ongoing), Independent Contractor (Ongoing); Regeneron: Advisor (Ongoing), Consultant (Ongoing); SkylineDx: Research Grant (Ongoing); Turnstone Biologics: Contracted Research (Ongoing), Research Grant (Ongoing); Ultimovacs: Consultant (Ongoing)

Author(s)

SB

Shay L. Bellasea, MS

Biostatistician
SWOG Statistics and Data Management Center and Fred Hutchinson Cancer Research Center, Seattle, WA, USA, United States

Disclosure information not submitted.
John R. Hyngstrom, MD

Associate Professor, Surgical Oncology
Huntsman Cancer Institute, University of Utah Health
Salt Lake City, Utah, United States

Disclosure(s): Amgen Inc. and Merck & Co., Inc.: Research Grant (Ongoing); BMS: Research Grant (Ongoing); Iovance Biotherapeutics: Research Grant (Ongoing); Natera Inc: Research Grant (Ongoing); Philogen: Research Grant (Ongoing); SkylineDx: Research Grant (Ongoing); Takara Bio: Research Grant (Ongoing)
Carlo M. Contreras, MD

Associate Professor, Section Head of Melanoma/Sarcoma
The Ohio State University
Columbus, Ohio, United States

Disclosure(s): Association of Community Cancer Centers: Speaker (Terminated, May 1, 2022); Ohio State University: Research Grant (Ongoing); OncLive: Speaker (Terminated, November 2, 2022); Total Health Conferencing: Speaker (Terminated, October 31, 2022)
Alicia M. Terando, MD (she/her/hers)

Regional Director of Surgical Oncology
Huntington Hospital Cancer Center, an Affiliate of Cedars Sinai Cancer
Pasadena, California, United States

Disclosure information not submitted.
MH

Michael A. Harrington, MD, MPH

Associate Professor of Surgery, Department of Plastic Surgery
USF Morsani College of Medicine, Tampa, FL, USA, United States

Disclosure information not submitted.
MM

Marcos M. Monroe, MD

Associate Professor, Otolaryngology-Head and Neck Surgery
Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA, United States

Disclosure information not submitted.
DW

David Wada, MD

Associate Professor, Department of Dermatology
Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA, United States

Disclosure information not submitted.
JP

Joseph A. Plaza, MD

Director of Dermatopathology, Professor of Pathology and Dermatology
Ohio State University Wexner Medical Center, Columbus, OH, USA, United States

Disclosure information not submitted.
ZE

Zeynep Eroglu, MD

Associate Member, Department of Cutaneous Oncology
Moffitt Cancer Center, Tampa, FL, USA, United States

Disclosure information not submitted.
SH

Siwen Hu-Lieskovan, MD, PhD

Associate Professor, Department of Medicine
Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA, United States

Disclosure information not submitted.
GI

Gino K. In, MD, MPH

Assistant Professor of Medicine and Dermatology
University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA, United States

Disclosure information not submitted.
AI

Alexandra P. Ikeguchi, MD

Assistant Professor of Medicine, Division of Hematology/Oncology
Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, United States

Disclosure information not submitted.
ES

Elad Sharon, MD, MPH

Senior Investigator
National Cancer Institute, Bethesda, MD, USA, United States

Disclosure information not submitted.
MW

Michael C. Wu, PhD

Biostatistician
SWOG Statistics and Data Management Center and Fred Hutchinson Cancer Research Center, Seattle, WA, USA, United States

Disclosure information not submitted.
JM

James Moon, MS

Biostatistician
SWOG Statistics and Data Management Center and Fred Hutchinson Cancer Research Center, Seattle, WA, USA, United States

Disclosure information not submitted.
AR

Antoni Ribas, MD, PhD

Professor of Medicine
University of California Los Angeles, Los Angeles, CA, USA, United States

Disclosure information not submitted.
SP

Sapna P. Patel, MD

Chair, SWOG Melanoma Committee; Associate Professor
MD Anderson Cancer Center, Houston, TX, USA, United States

Disclosure information not submitted.
WC

William Carson, III, MD

Professor, Division of Surgical Oncology
Ohio State University James Cancer Hospital, Columbus, OH, USA, United States

Disclosure information not submitted.
KK

Kari L. Kendra, MD, PhD

Professor, Division of Medical Oncology, Department of Medicine
Ohio State University James Cancer Hospital, Columbus, OH, USA, United States

Disclosure information not submitted.

Disclosure(s):

Vernon K. Sondak, MD: Alkermes: Independent Contractor (Ongoing); AmLO Biosciences: Advisor (Ongoing), Consultant (Ongoing); Bristol-Myers Squibb: Advisor (Ongoing), Consultant (Ongoing); Genesis Drug Discovery & Development: Independent Contractor (Ongoing); Iovance Biotherapeutics: Advisor (Ongoing), Consultant (Ongoing); Merck & Co., Inc.: Advisor (Ongoing), Consultant (Ongoing); Neogene Therapeutics: Research Grant (Ongoing); Novartis Pharmaceuticals Corporation: Advisor (Ongoing), Independent Contractor (Ongoing); Regeneron: Advisor (Ongoing), Consultant (Ongoing); SkylineDx: Research Grant (Ongoing); Turnstone Biologics: Contracted Research (Ongoing), Research Grant (Ongoing); Ultimovacs: Consultant (Ongoing)

John R. Hyngstrom, MD: Amgen Inc. and Merck & Co., Inc.: Research Grant (Ongoing); BMS: Research Grant (Ongoing); Iovance Biotherapeutics: Research Grant (Ongoing); Natera Inc: Research Grant (Ongoing); Philogen: Research Grant (Ongoing); SkylineDx: Research Grant (Ongoing); Takara Bio: Research Grant (Ongoing)

Carlo M. Contreras, MD: Association of Community Cancer Centers: Speaker (Terminated, May 1, 2022); Ohio State University: Research Grant (Ongoing); OncLive: Speaker (Terminated, November 2, 2022); Total Health Conferencing: Speaker (Terminated, October 31, 2022)

Introduction: Desmoplastic melanoma often presents with deeply invasive, locally advanced disease, particularly on the head or neck in elderly patients. Wide excision often creates large, defects requiring complex reconstruction with high risk of local and distant relapse. Neoadjuvant pembrolizumab was evaluated in SWOG S1512; this report covers surgical aspects of that clinical trial.

Methods: 29 patients ≥18 years with resectable AJCC 8^th edition stage IIB, IIC or III desmoplastic melanoma and residual tumor present received up to 4 doses of pembrolizumab 200 IV Q3W prior to planned surgery. The surgical findings are described in this post hoc analysis.

Results: Of the 29 patients receiving at least one dose of pembrolizumab treatment, 20 (69%) had desmoplastic melanoma of the head or neck (scalp 7, forehead 4, nose 3, cheek 2, lip 2, neck 2), 5 (17%) extremity and 3 (10%) trunk (primary site unknown in 1 [3%]). Median age was 75 years (range 37-91) and 22 (76%) were male. 23 (79%) of tumors were primary, the rest were recurrent/nodal metastatic. One patient with a lip primary who had a clinical complete response to preoperative pembrolizumab refused surgery; the remaining 28 patients all underwent surgery, most after 3 cycles of treatment, between 52 and 135 days (median 81 days) after beginning pembrolizumab. No patient experienced disease progression or metastasis precluding surgery; 26 patients underwent wide excision of primary/recurrent disease, with no residual viable tumor at the site in 21 (81%). Only two patients required reexcision (one twice) to obtain negative margins, and one of them received postoperative radiation. Sentinel lymph node biopsy was performed in 17 clinically node-negative patients, with 1 (6%) found to have a positive node. Lymphadenectomy was performed on 3 additional patients with clinical stage III disease; only 1 (33%) had residual viable tumor. After a median follow-up of 16 months, there have been no local, regional or distant recurrences.

Conclusions: Neoadjuvant pembrolizumab can be successfully administered to patients with desmoplastic melanoma, allowing for resection in virtually all patients, with high rates of pathologic response and low rates of positive margins requiring further surgery or radiation therapy. Further evaluation of this promising treatment strategy is warranted.

Learning Objectives:

At the conclusion of this session, participants should be able to describe surgical outcomes for patients enrolled on SWOG S1512, wherein all patients received neoadjuvant pembrolizumab.
At the conclusion of this session, participants should have a better understanding of the surgical challenges associated with desmoplastic melanoma management.
At the conclusion of this session, participants should have an improved understanding of the role of neoadjuvant pembrolizumab in the management of desmoplastic melanoma.