In the past, the path to treating melanoma or advanced skin cancer was almost always the same: surgery first. But modern medicine thinks differently. Meet the “neoadjuvant” approach – the treatment that prepares the body, shrinks the tumor and improves the chances of recovery even before you enter the operating room.
Neoadjuvant therapy is a drug treatment given before surgery. The word “neo” means new/preceding, and “adjuvant” means assisting. That is, it is a treatment intended to help the surgery succeed and to increase the chances of a full recovery from skin cancer. Skin cancer cells that break away from the main tumor and circulate in the body (“micrometastases”) pose a significant risk of the disease returning or of metastases developing. Therefore, the treatment plan includes removing the tumor that can be seen with the eye (surgery) and also drug treatment for the cells circulating in the body, which cannot be seen even in the most advanced imaging tests.
Recovery depends on the ability of the immune system to eliminate the micrometastases, down to the last cell. Our immune system knows how to deal with skin cancer cells, especially in melanoma, squamous cell carcinoma (SCC) and Merkel cell carcinoma, in the best and most precise way. Advanced biologic and immunotherapy drugs help the immune system recognize and attack skin cancer cells in an improved way. It turns out that they work much better when the tumor that can be seen with the eye is still in the body, that is, before the final surgery.
You can imagine it, for example, by thinking of the immune system as an army deployed against the enemy – the skin cancer cells. According to the neoadjuvant approach, we train our army while it sees the targets in front of it, learns them and develops improved capabilities against them. After the training is complete, we remove the targets (surgery) and send the soldiers to search the whole body for the targets they already know well. By contrast, in the “surgery first” approach followed by immunotherapy, the army is trained on targets it has to imagine, because they are no longer placed in front of it, and then the soldiers are sent to look for the imagined targets throughout the body.
Which approach makes more sense?
This logic has been proven in research. For example, in melanoma the SWOG-S1801 study showed a clear advantage for the “neoadjuvant” approach and a 30% improvement in reducing the risk of disease recurrence, including metastatic disease, compared with the “surgery first” approach. The NADINA study in melanoma showed that treatment with 2 doses of combined immunotherapy before surgery led to a 70% improvement in reducing the risk of disease recurrence compared with the “surgery first” approach. Results in a similar spirit are also seen in other skin cancers that are not melanoma.
This approach changes the rules of the game for our patients at On.Top, thanks to three main goals:
Bottom line – recent studies show that in tumors suitable for this approach the results are better, both in terms of survival and quality of life, and in terms of side effects and aesthetic results, compared with the old approach of surgery first.
The physicians at On.Top tailor the type of treatment personally (Personalized Medicine) according to the type of tumor and its genetics:
Neoadjuvant treatment in skin cancer is not just “giving a drug”. It requires complex decision-making, precise timing with the surgeons and in-depth familiarity with all the different layers of skin cancers as well as the up-to-date literature in the field. This is exactly where On.Top’s advantage comes in.
At the On.Top center, your treatment is managed by a multidisciplinary team among the leading ones in Israel:
Neoadjuvant (before): Treatment given before surgery in order to treat “micrometastases” and improve the chances of long-term cure, and sometimes even to minimize the surgery.
If you have been diagnosed with melanoma or skin cancer, or have a suspicious lesion – know that there are advanced treatment options today that did not exist in the past. The first step to recovery is an accurate diagnosis and building a smart treatment plan.
The On.Top experts are here for you. We invite you to a personal consultation, in which we will examine your case in depth and tailor the right and safest medical route for you.
In simple words, this is giving a drug treatment (usually immunotherapy or biological therapy) before the surgery to remove the tumor, and not after it. The aim is to attack the tumor while it is still in the body, and to use its presence to activate the immune system more effectively against the cancer.
This is the most common question. The instinct is to “cut, and fast”, but new studies show that a “strategic wait” in order to give treatment can actually save lives. The preliminary treatment is not a “waste of time” – on the contrary. It allows us to:
Shrink the tumor and make the surgery easier and more precise.
Treat microscopic metastases that may already be circulating in the body and are not visible on scans.
Get “intelligence” in real time: to see whether the tumor responds to the drug before we remove it.
In most cases, no. Surgery is still a central part of the treatment, but it comes at the second stage. In some cases, if the tumor disappears completely following the drug treatment, avoiding extensive surgery may be considered, but this is a decision made case by case by the medical team.
No. Neoadjuvant treatment is usually intended for situations in which the tumor is resectable (can be operated on) but is at a locally advanced stage (stage 3), for example when lymph nodes are involved. The decision whether you are suitable for this protocol requires an accurate diagnosis and the strategic view of a specialist oncologist. That is exactly why we are here.
We are in close and continuous follow-up throughout the period. If we see that the treatment is not working as expected, we do not wait – we refer immediately to surgery. The advantage is that we learned something important: we knew that this specific drug is less effective for you, which will save us precious time in choosing the complementary treatment after surgery.
