[Escalation and de-escalation of therapy for high-risk melanomas].

Abstract

Introduction: For a long time, advanced melanoma was a difficult-to-treat disease with no effective survival strategies. With the development of checkpoint inhibitors and kinase inhibitors in the 21st century, treatment options have improved considerably. Recent studies indicate that adjuvant therapy with anti-PD1-antibodies significantly improves the recurrence-free survival in stage IIB/C patients without lymph node involvement. However, the challenge is to identify the right patients for long-term treatment, as many could be cured by surgery alone. Neoadjuvant therapy, in which systemic treatment is administered before the surgical removal of the macroscopic lymph node metastases, has proven to be promising. Neoadjuvant approaches, particularly with anti-PD1-antibodies, can significantly reduce the recurrence rate. Additionally, histological analysis of tumor tissue after neoadjuvant therapy could help identify patients who do not require further adjuvant treatment, thereby reducing side effects and costs. However, the implementation of neoadjuvant therapy in clinical practice faces challenges, such as the lack of approval in Switzerland and the need for specialized histopathological assessments. Future research efforts should focus on developing criteria for patient selection and validating the role of histopathological examinations in prognosis. A de-escalation of therapeutic approaches could lead to more patient-centered, resource-efficient medicine.