Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma

M. T. Tetzlaff; J. L. Messina; J. E. Stein; X. Xu; R. N. Amaria; C. U. Blank; B. A. Van De Wiel; P. M. Ferguson; R. V. Rawson; M. I. Ross; A. J. Spillane; J. E. Gershenwald; R. P.M. Saw; A. C.J. Van Akkooi; W. J. Van Houdt; T. C. Mitchell; A. M. Menzies; G. V. Long; J. A. Wargo; M. A. Davies; V. G. Prieto; J. M. Taube; R. A. Scolyer

doi:10.1093/annonc/mdy226

Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma

M. T. Tetzlaff, J. L. Messina, J. E. Stein, X. Xu, R. N. Amaria, C. U. Blank, B. A. Van De Wiel, P. M. Ferguson, R. V. Rawson, M. I. Ross, A. J. Spillane, J. E. Gershenwald, R. P.M. Saw, A. C.J. Van Akkooi, W. J. Van Houdt, T. C. Mitchell, A. M. Menzies, G. V. Long, J. A. Wargo, M. A. DaviesV. G. Prieto, J. M. Taube, R. A. Scolyer

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122 Scopus citations

Abstract

Background: Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment. Methods: The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines. Results: Based on our collective experience and guided by efforts in well-established neoadjuvant settings like Breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy–treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated. Conclusions: Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.

Original language	English (US)
Pages (from-to)	1861-1868
Number of pages	8
Journal	Annals of Oncology
Volume	29
Issue number	8
DOIs	https://doi.org/10.1093/annonc/mdy226
State	Published - Aug 2018

Keywords

Immune checkpoint blockade
Melanoma
Neoadjuvant therapy
Pathology
Targeted therapy

ASJC Scopus subject areas

Hematology
Oncology

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10.1093/annonc/mdy226

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Tetzlaff, M. T., Messina, J. L., Stein, J. E., Xu, X., Amaria, R. N., Blank, C. U., Van De Wiel, B. A., Ferguson, P. M., Rawson, R. V., Ross, M. I., Spillane, A. J., Gershenwald, J. E., Saw, R. P. M., Van Akkooi, A. C. J., Van Houdt, W. J., Mitchell, T. C., Menzies, A. M., Long, G. V., Wargo, J. A., ... Scolyer, R. A. (2018). Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma. Annals of Oncology, 29(8), 1861-1868. https://doi.org/10.1093/annonc/mdy226

Tetzlaff, MT, Messina, JL, Stein, JE, Xu, X, Amaria, RN, Blank, CU, Van De Wiel, BA, Ferguson, PM, Rawson, RV, Ross, MI, Spillane, AJ, Gershenwald, JE, Saw, RPM, Van Akkooi, ACJ, Van Houdt, WJ, Mitchell, TC, Menzies, AM, Long, GV, Wargo, JA , Davies, MA , Prieto, VG, Taube, JM & Scolyer, RA 2018, 'Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma', Annals of Oncology, vol. 29, no. 8, pp. 1861-1868. https://doi.org/10.1093/annonc/mdy226

@article{3658115ea49345b7965b4d1f2b05380a,

title = "Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma",

abstract = "Background: Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment. Methods: The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines. Results: Based on our collective experience and guided by efforts in well-established neoadjuvant settings like Breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy–treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated. Conclusions: Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.",

keywords = "Immune checkpoint blockade, Melanoma, Neoadjuvant therapy, Pathology, Targeted therapy",

author = "Tetzlaff, {M. T.} and Messina, {J. L.} and Stein, {J. E.} and X. Xu and Amaria, {R. N.} and Blank, {C. U.} and {Van De Wiel}, {B. A.} and Ferguson, {P. M.} and Rawson, {R. V.} and Ross, {M. I.} and Spillane, {A. J.} and Gershenwald, {J. E.} and Saw, {R. P.M.} and {Van Akkooi}, {A. C.J.} and {Van Houdt}, {W. J.} and Mitchell, {T. C.} and Menzies, {A. M.} and Long, {G. V.} and Wargo, {J. A.} and Davies, {M. A.} and Prieto, {V. G.} and Taube, {J. M.} and Scolyer, {R. A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2018.",

year = "2018",

month = aug,

doi = "10.1093/annonc/mdy226",

language = "English (US)",

volume = "29",

pages = "1861--1868",

journal = "Annals of Oncology",

issn = "0923-7534",

publisher = "Oxford University Press",

number = "8",

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TY - JOUR

T1 - Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma

AU - Tetzlaff, M. T.

AU - Messina, J. L.

AU - Stein, J. E.

AU - Xu, X.

AU - Amaria, R. N.

AU - Blank, C. U.

AU - Van De Wiel, B. A.

AU - Ferguson, P. M.

AU - Rawson, R. V.

AU - Ross, M. I.

AU - Spillane, A. J.

AU - Gershenwald, J. E.

AU - Saw, R. P.M.

AU - Van Akkooi, A. C.J.

AU - Van Houdt, W. J.

AU - Mitchell, T. C.

AU - Menzies, A. M.

AU - Long, G. V.

AU - Wargo, J. A.

AU - Davies, M. A.

AU - Prieto, V. G.

AU - Taube, J. M.

AU - Scolyer, R. A.

PY - 2018/8

Y1 - 2018/8

N2 - Background: Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment. Methods: The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines. Results: Based on our collective experience and guided by efforts in well-established neoadjuvant settings like Breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy–treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated. Conclusions: Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.

AB - Background: Clinical trials have recently evaluated safety and efficacy of neoadjuvant therapy among patients with surgically resectable regional melanoma metastases. To capture informative prognostic data connected to pathological response in such trials, it is critical to standardize pathologic assessment and reporting of tumor response after this treatment. Methods: The International Neoadjuvant Melanoma Consortium meetings in 2016 and 2017 assembled pathologists from academic centers to develop consensus guidelines for pathologic examination and reporting of surgical specimens from AJCC (8th edition) stage IIIB/C/D or oligometastatic stage IV melanoma patients treated with neoadjuvant-targeted or immune therapy. Patterns of pathologic response are provided context to inform these guidelines. Results: Based on our collective experience and guided by efforts in well-established neoadjuvant settings like Breast cancer, procedures directing handling of pre- and post-neoadjuvant therapy–treated melanoma specimens are provided to facilitate comparison of findings across different trials and centers. Definitions of pathologic response are provided together with guidelines for reporting and quantifying the extent of pathologic response. Finally, the spectrum of histopathologic responses observed following neoadjuvant-targeted and immune-checkpoint therapy is described and illustrated. Conclusions: Standardizing pathologic evaluation of resected melanoma metastases following neoadjuvant-targeted or immune-checkpoint therapy allows more robust stratification of patient outcomes. This includes recognizing the spectrum of histopathologic response patterns to neoadjuvant therapy and a standard approach to grading pathologic responses. Such an approach will facilitate comparison of results across clinical trials and inform ongoing correlative studies into the mechanisms of response and resistance to agents applied in the neoadjuvant setting.

KW - Immune checkpoint blockade

KW - Melanoma

KW - Neoadjuvant therapy

KW - Pathology

KW - Targeted therapy

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U2 - 10.1093/annonc/mdy226

DO - 10.1093/annonc/mdy226

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AN - SCOPUS:85055505227

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EP - 1868

JO - Annals of Oncology

JF - Annals of Oncology

IS - 8

ER -

Pathological assessment of resection specimens after neoadjuvant therapy for metastatic melanoma

Abstract

Keywords

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