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Recurrence After Adjuvant ICI — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinRecurrence After Adjuvant ICISCE Medical Oncology

A 55-year-old man with melanoma has completed adjuvant pembrolizumab for stage IIIB disease. At 2-year surveillance, PET-CT shows a single suspicious FDG-avid inguinal lymph node. Biopsy confirms recurrent melanoma. What is the most appropriate management?

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Correct answer: C — Surgical resection of the oligorecurrent lesion + anti-PD-1 rechallenge — recurrence after adjuvant ICI does not preclude ICI retreatment; response rates to rechallenge are meaningful

Recurrence after adjuvant anti-PD-1 does NOT mean the patient is ICI-refractory. The disease may have recurred from ICI-resistant clones or after immune memory has waned. Anti-PD-1 rechallenge for recurrence after adjuvant ICI achieves response rates of approximately 40-60% in retrospective series. For oligorecurrent disease (single site), surgical resection ± systemic ICI rechallenge provides the best chance of disease control. BRAF mutation status should guide targeted therapy consideration if present.

Reference: ESMO 2024 Melanoma; Owen et al Ann Oncol 2021