Talimogene laherparepvec

Neoadjuvant ori+tori therapy in resectable stage III and IVM1a acral melanoma (AM) showed 77.8% pathological response, 85.2% 1-year RFS, and 81.5% 2-year RFS, surpassing previous adjuvant therapy alone. Limited data exist on adjuvant or neoadjuvant settings for AM, with most from retrospective studies showing RFS from 14.8 to 26 months. The NADINA study demonstrated neoadjuvant ipilimumab and nivolumab improved EFS over adjuvant nivolumab. AM is less responsive to immunotherapy; anti-PD-1 monotherapy ORR was 18.0% with median PFS of 3–5 months. Combination therapy of anti-PD-1 with oncolytic virus showed 77.8% pathological response, suggesting potential in advanced AM. Oncolytic virus modifies tumor microenvironment, enhancing immune cell activity and sensitivity to immunotherapy. Pathologic response is critical for neoadjuvant therapy efficacy; neoadjuvant ori+tori offered significant advantages over oncolytic virus monotherapy. Safety profiles were favorable, with 13.3% grade 3 AEs. PET/CT showed no correlation with pathological response, necessitating new evaluation technologies. These preliminary data encourage further controlled trials, especially in unresectable metastatic AM.