Current status and novel insights into the role of metastasectomy in the era of immunotherapy

ABSTRACT

Introduction

New perspectives on the role of metastasectomy have emerged along with the advances in cancer immunotherapy. Despite accumulating evidence that encourages the use of immunotherapy in the metastatic setting, current data regarding its combination with surgical resection of secondary lesions, as well as the best timeline and sequence of such a therapeutic approach is limited.

Areas covered

We review the currently available literature on the role of metastasectomy in the era of novel immunotherapeutic agents and provide comprehensive evidence from ongoing trials about the available treatment strategies. In metastatic melanoma, immune checkpoint inhibitors (ICIs) play a key role both in the neoadjuvant and adjuvant setting to achieve long-term disease control. In metastatic renal cell carcinoma, investigation is ongoing regarding the emerging role of ICIs before metastasectomy. ICIs have improved outcomes in patients with metastatic colorectal and head and neck cancer.

Expert opinion

In the neoadjuvant setting, the high response rates and the durability of responses to immunotherapy may enable the resectability of metastatic lesions. In the adjuvant setting post metastasectomy, immunotherapy constitutes a safe and efficacious approach to support immune tumor surveillance and delay or even prevent disease relapse. Patient participation in relevant clinical trials should be encouraged.

KEYWORDS:

• Immunotherapy
• immune check-point inhibitors
• metastasectomy
• oligometastasis
• surgical resection

Article highlights

• New perspectives on the role of metastasectomy have emerged along with the advances in cancer immunotherapy, especially in melanoma and renal cell carcinoma.

• In the neoadjuvant setting, high response rates and the durability of responses may enable the resectability of metastatic lesions.

• In the adjuvant setting, immunotherapy supports immune tumor surveillance and may delay or even prevent disease relapse.

• Patient participation in relevant clinical trials should be encouraged.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.