# Opportunities for Discovery Using Neoadjuvant Immune Checkpoint Blockade in Melanoma

## TL;DR

This review explores how neoadjuvant immunotherapy improves melanoma treatment and highlights the need for better biomarkers to predict patient responses.

## Contribution

The paper emphasizes the need for new predictive biomarkers beyond canonical proteins to improve personalized immunotherapy for melanoma.

## Key findings

- Neoadjuvant immunotherapy improves event-free survival in advanced melanoma.
- Canonical proteins are inconsistent indicators of treatment response.
- Post-treatment tumor analysis offers insights into ICI efficacy.

## Abstract

Treatment of resectable advanced-stage melanoma with neoadjuvant immunotherapy is rapidly becoming the new standard of care due to significant improvements in event-free survival (EFS) compared to surgery first followed by immunotherapy. The level of responsiveness seen in patients receiving immune checkpoint inhibitors (ICIs) must be mechanistically understood not only for the standardization of treatment but also to advance the novel concept of personalized cancer immunotherapy. This review aims to elucidate markers of the tumor microenvironment (TME) and blood that can predict treatment outcome. Interestingly, the canonical proteins involved in the molecular interactions that immunotherapies aim to disrupt have not been consistent indicators of treatment response, which amplifies the necessity for further research on the predictive model. Other major discussions surrounding neoadjuvant therapy involve the higher-level investigation of ICI efficacy due to the ability to examine a post-treatment tumor molecularly and pathologically, which this review will also cover. As neoadjuvant ICI becomes the standard of care in advanced melanoma treatment, further research aiming to identify more predictive biomarkers of treatment response to advance medical decision-making and patient care should continue to be sought after.