Perioperative PD‐1‐inhibition in melanoma patients – a retrospective analysis from eight German skin cancer centers

BACKGROUND: Adjuvant therapy with anti-PD-1 monotherapy in melanoma is well established. However, a perioperative approach starting immunotherapy before surgery appears mechanistically more reasonable and emerging research results suggest a clinical benefit. This study aims to provide a comprehensive overview of the current use of perioperative anti-PD-1 monotherapy in Germany. PATIENTS AND METHODS: Patients with stage III melanoma who received perioperative anti-PD-1 monotherapy from April 2019 to March 2025 were included. Data from eight German skin cancer centers were retrospective collected including histological and radiological assessments. RESULTS: We identified 75 melanoma patients with perioperative anti-PD-1 monotherapy. Surgery was conducted in 75% of patients after a median of 11 weeks after therapy initiation. Pathological assessment revealed a major pathological response (MPR) in 46.5% of cases, a partial pathological response in 23.2%, and no pathological response in 30.4%. A moderate to strong correlation between radiological and pathological responses was identified. During a median follow up period of 11.6 months, melanoma recurrence was observed in 16 patients (21%). The longest recurrence-free survival was seen in the MPR group. CONCLUSIONS: Perioperative anti-PD-1 monotherapy has been implemented in routine clinical practice in German skin cancer centers. The observed outcomes are comparable to data reported from prospective studies.