Current and Emerging Opportunities for De-Intensification of Systemic Therapies in Melanoma: A Scoping Review
| Thursday, August 14, 2025 |
| 11:07 AM - 11:14 AM |
| Ballroom 2 and 3 |
Overview
Dr Jennifer Soon
Speaker
Dr Jennifer Soon
Medical Oncologist
University Of Melbourne
Current and Emerging Opportunities for De-Intensification of Systemic Therapies in Melanoma: A Scoping Review
Abstract
BACKGROUND
There is growing interest in optimising melanoma treatment to reduce over-treatment and improve patient safety and quality-of-life, yet current clinical guidance on de-intensification is minimal. This scoping review characterises the role of systemic therapies and biomarkers in current and emerging melanoma de-intensification strategies. Study types, funding sources, and use of patient-reported outcomes (PRO) were also summarised.
METHODS
MEDLINE, EMBASE and PubMed searches identified studies on de-intensification in adult patients with cutaneous melanoma (Jan 2013 to Jun 2023). Additional texts were sourced via Google Scholar and backward citation searches. Three extraction tools were tailored to accommodate the breadth of articles included: A) de-intensification approaches including biomarkers in late-phase development; B) non-systematic reviews; and C) early-phase biomarkers. Screening and data extraction were performed by two reviewers using Covidence. Data were analysed using descriptive statistics with results reported as per PRISMA-ScR guidelines.
RESULTS
Of 3,721 articles screened, 301 articles were included: 31 non-systematic reviews, 198 early-phase biomarker studies, and 72 studies on de-intensification approaches (Fig. 1). Five key approaches emerged: shortened duration of therapy, dose attenuation, biomarker-informed, neoadjuvant and/or response-adapted, and miscellaneous. Most data were retrospective; only five randomised controlled trials were included in Category A (two were trial protocols). 66% of articles were of early-phase biomarkers – very few progressed to trials of clinical validation/utility. PRO were reported in 11% of Category A studies.
CONCLUSION
Shortened duration of anti-PD-1 therapy and neoadjuvant approaches hold substantial promise in de-intensification. Future trials should prioritise consistent incorporation of PRO and focus on determining clinical utility of biomarkers.
We acknowledge the expertise of Ms Smaro Lazarakis, Clinical and Research Librarian at the Health Sciences Library of Melbourne Health, in supporting the search strategy development.
This study received no external funding. Dr Soon is supported by the Melbourne Research and Australian Government Research Training Program Scholarships.
There is growing interest in optimising melanoma treatment to reduce over-treatment and improve patient safety and quality-of-life, yet current clinical guidance on de-intensification is minimal. This scoping review characterises the role of systemic therapies and biomarkers in current and emerging melanoma de-intensification strategies. Study types, funding sources, and use of patient-reported outcomes (PRO) were also summarised.
METHODS
MEDLINE, EMBASE and PubMed searches identified studies on de-intensification in adult patients with cutaneous melanoma (Jan 2013 to Jun 2023). Additional texts were sourced via Google Scholar and backward citation searches. Three extraction tools were tailored to accommodate the breadth of articles included: A) de-intensification approaches including biomarkers in late-phase development; B) non-systematic reviews; and C) early-phase biomarkers. Screening and data extraction were performed by two reviewers using Covidence. Data were analysed using descriptive statistics with results reported as per PRISMA-ScR guidelines.
RESULTS
Of 3,721 articles screened, 301 articles were included: 31 non-systematic reviews, 198 early-phase biomarker studies, and 72 studies on de-intensification approaches (Fig. 1). Five key approaches emerged: shortened duration of therapy, dose attenuation, biomarker-informed, neoadjuvant and/or response-adapted, and miscellaneous. Most data were retrospective; only five randomised controlled trials were included in Category A (two were trial protocols). 66% of articles were of early-phase biomarkers – very few progressed to trials of clinical validation/utility. PRO were reported in 11% of Category A studies.
CONCLUSION
Shortened duration of anti-PD-1 therapy and neoadjuvant approaches hold substantial promise in de-intensification. Future trials should prioritise consistent incorporation of PRO and focus on determining clinical utility of biomarkers.
We acknowledge the expertise of Ms Smaro Lazarakis, Clinical and Research Librarian at the Health Sciences Library of Melbourne Health, in supporting the search strategy development.
This study received no external funding. Dr Soon is supported by the Melbourne Research and Australian Government Research Training Program Scholarships.
Biography
Dr Jennifer Soon is a Medical Oncologist at Peter MacCallum Cancer Centre pursuing her doctoral studies through the University of Melbourne. She has a special interest in health policy, data science and improving healthcare value and access for people. Her research has contributed to the development of a flexible and responsive method for horizon scanning of new medicines. Dr Soon is an Executive Committee Member of the Medical Oncology Group of Australia (MOGA) and is on the MOGA Oncology Drugs Working Group.
Session Chair
Tim Clay
St John Of God Subiaco Hospital
