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Treatment Strategy

Neoadjuvant Therapy

Treatment before surgery–where functional biomarkers could predict pathologic response and guide surgical decisions.

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Definition
Neoadjuvant therapy is systemic treatment administered before definitive local therapy (usually surgery). Goals include downsizing tumors, enabling less extensive surgery, and providing early assessment of treatment sensitivity. Pathologic complete response (pCR)–no residual invasive cancer at surgery–correlates with long-term outcomes. Functional biomarkersLoading... could predict pCR before treatment, guiding therapy selection and surgical planning.
Before Surgery
Systemic therapy first
pCR Endpoint
No residual cancer
Downsizing
Enable organ preservation
Prediction
Functional biomarkers guide selection

The Neoadjuvant Paradigm

Traditionally, surgery came first, with systemic therapy given afterward (adjuvant). Neoadjuvant reverses this sequence, offering key advantages: tumor response assessment in vivo, potential downsizing enabling less radical surgery, and early treatment of micrometastatic disease.

In melanomaLoading..., neoadjuvant checkpoint immunotherapy is under active investigation. Patients achieving pCR have excellent long-term outcomes, while non-responders may need alternative approaches. The challenge: predicting response before initiating treatment.

Simplified

Treatment Before Surgery: Neoadjuvant therapy is given before the main treatment (usually surgery) to shrink tumors and get early information about treatment response.

Key Advantage: You can see the tumor tissue response. If the tumor disappears (pathologic complete response), that's strong evidence the treatment worked.

Functional Biomarker Opportunity

Pretreatment biopsies offer an opportunity for biomarker-guided neoadjuvant selection. If iFRETLoading... measurement of checkpoint engagement predicts immunotherapy response, patients could be stratified before treatment: high engagement ' likely responder ' proceed with neoadjuvant ICI; low engagement ' unlikely responder ' consider alternative approaches.

The HAWK/OSU collaboration is testing this concept in stage II melanoma patients receiving neoadjuvant oncolytic virus therapy.

Simplified

Paired Samples: Neoadjuvant studies provide pre-treatment AND post-treatment tissue from the same patient.

Why This Matters: You can track how functional biomarkers change with treatment and correlate changes with response. The TVEC melanoma study showed responders had different iFRET patterns than non-responders.

Treat Then Assess
Give neoadjuvant therapy, assess response at surgery
Predict Then Treat
Use functional biomarkers to predict response, then select optimal neoadjuvant approach

Clinical Applications

  • Response prediction: Identify likely responders before initiating neoadjuvant therapy
  • Therapy selection: Guide choice between ICILoading..., chemotherapy, targeted therapy
  • Organ preservation: Predict who can avoid radical surgery after neoadjuvant response
  • Surgical timing: Optimize interval between treatment and surgery based on predicted response kinetics

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