Local Adjuvant Treatment with Low-Dose CpG-B Offers Durable Protection against Disease Recurrence in Clinical Stage I–II Melanoma: Data from Two Randomized Phase II Trials

Abstract

<b>Purpose:</b> Although risk of recurrence after surgical removal of clinical stage I-II melanoma is considerable, there is no adjuvant therapy with proven efficacy. Here, we provide clinical evidence that a local conditioning regimen, aimed at immunologic arming of the tumor-draining lymph nodes, may provide durable protection against disease recurrence (median follow-up, 88.8 months).<b>Experimental Design:</b> In two randomized phase II trials, patients, diagnosed with stage I-II melanoma after excision of the primary tumor, received local injections at the primary tumor excision site within 7 days preceding re-excision and sentinel lymph node (SLN) biopsy of either a saline placebo (<i>n</i> = 22) or low-dose CpG type B (CpG-B) with (<i>n</i> = 9) or without (<i>n</i> = 21) low-dose GM-CSF.<b>Results:</b> CpG-B treatment was shown to be safe, to boost locoregional and systemic immunity, to be associated with lower rates of tumor-involved SLN (10% vs. 36% in controls, <i>P</i> = 0.04), and, at a median follow-up of 88.8 months, to profoundly improve recurrence-free survival (<i>P</i> = 0.008), even for patients with histologically confirmed (i.e., pathologic) stage I-II disease (<i>P</i> = 0.02).<b>Conclusions:</b> Potentially offering durable protection, local low-dose CpG-B administration in early-stage melanoma provides an adjuvant treatment option for a large group of patients currently going untreated despite being at considerable risk for disease recurrence. Once validated in a larger randomized phase III trial, this nontoxic immunopotentiating regimen may prove clinically transformative. <i>Clin Cancer Res; 23(19); 5679-86. ©2017 AACR</i>.