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A single dose of neoadjuvant PD-1 blockade predicts clinical outcomes in resectable melanoma

Open access
Huang, Alexander C., Orlowski, Robert J., Xu, Xiaowei, Mick, Rosemarie, George, Sangeeth M., Yan, Patrick K., Manne, Sasikanth, Kraya, Adam A., Wubbenhorst, Bradley, Dorfman, Liza, D’Andrea, Kurt, Wenz, Brandon M., Liu, Shujing, Chilukuri, Lakshmi, Kozlov, Andrew, Carberry, Mary, Giles, Lydia, Kier, Melanie W., Quagliarello, Felix, McGettigan, Suzanne, Kreider, Kristin, Annamalai, Lakshmanan, Zhao, Qing, Mogg, Robin, Xu, Wei, Blumenschein, Wendy M., Yearley, Jennifer H., Linette, Gerald P., Amaravadi, Ravi K., Schuchter, Lynn M., Herati, Ramin S., Bengsch, Bertram, Nathanson, Katherine L., Farwell, Michael D., Karakousis, Giorgos C., Wherry, E. John, Mitchell, Tara C.·2019·Nature Medicine

Abstract

Immunologic responses to anti-PD-1 therapy in melanoma patients occur rapidly with pharmacodynamic T cell responses detectable in blood by 3 weeks. It is unclear, however, whether these early blood-based observations translate to the tumor microenvironment. We conducted a study of neoadjuvant/adjuvant anti-PD-1 therapy in stage III/IV melanoma. We hypothesized that immune reinvigoration in the tumor would be detectable at 3 weeks and that this response would correlate with disease-free survival. We identified a rapid and potent anti-tumor response, with 8 of 27 patients experiencing a complete or major pathological response after a single dose of anti-PD-1, all of whom remain disease free. These rapid pathologic and clinical responses were associated with accumulation of exhausted CD8 T cells in the tumor at 3 weeks, with reinvigoration in the blood observed as early as 1 week. Transcriptional analysis demonstrated a pretreatment immune signature (neoadjuvant response signature) that was associated with clinical benefit. In contrast, patients with disease recurrence displayed mechanisms of resistance including immune suppression, mutational escape, and/or tumor evolution. Neoadjuvant anti-PD-1 treatment is effective in high-risk resectable stage III/IV melanoma. Pathological response and immunological analyses after a single neoadjuvant dose can be used to predict clinical outcome and to dissect underlying mechanisms in checkpoint blockade. Neoadjuvant PD-1 blockade in patients with resectable melanoma followed by adjuvant maintenance results in early immunological effects driving clinical benefit and reveals transcriptional and genomic mechanisms of response.

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Authors
Huang, A. C., Orlowski, R. J., Xu, X., Mick, R., George, S. M., Yan, P. K., Manne, S., Kraya, A. A., Wubbenhorst, B., Dorfman, L., D’Andrea, K., Wenz, B. M., Liu, S., Chilukuri, L., Kozlov, A., Carberry, M., Giles, L., Kier, M. W., Quagliarello, F., McGettigan, S., Kreider, K., Annamalai, L., Zhao, Q., Mogg, R., Xu, W., Blumenschein, W. M., Yearley, J. H., Linette, G. P., Amaravadi, R. K., Schuchter, L. M., Herati, R. S., Bengsch, B., Nathanson, K. L., Farwell, M. D., Karakousis, G. C., Wherry, E. J., & Mitchell, T. C.
Venue
Nature Medicine
Published
2019-02-25
Volume
25
Issue
3
Pages
454-461
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W2916647762
Cited by
686
References
42
FWCI
33.01
Type
journal article
Language
en
Open access
green

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CoChat. (2026). Citation check: A single dose of neoadjuvant PD-1 blockade predicts clinical outcomes in resectable melanoma. https://app.cochat.ai/papers/10.1038/s41591-019-0357-y
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Huang, A. C., Orlowski, R. J., Xu, X., Mick, R., George, S. M., Yan, P. K., Manne, S., Kraya, A. A., Wubbenhorst, B., Dorfman, L., D’Andrea, K., Wenz, B. M., Liu, S., Chilukuri, L., Kozlov, A., Carberry, M., Giles, L., Kier, M. W., Quagliarello, F., . . . Mitchell, T. C. (2019). A single dose of neoadjuvant PD-1 blockade predicts clinical outcomes in resectable melanoma. Nature Medicine. https://doi.org/10.1038/s41591-019-0357-y

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