MIA is experiencing great success with multi-discipline trials in the neo-adjuvant and adjuvant settings.

In high risk Stage III patients (where the melanoma has travelled to lymph nodes), a combination of two targeted therapies is given for 12 weeks prior to lymph node removal surgery, with the aim of shrinking the tumour to facilitate as easy and simple an operation as possible, and to prevent the risk of recurrence (normally around 50%). Following surgery, the same therapies are given for another 40 weeks (in total, drug therapy is received for 52 weeks). An interim analysis presented at ASCO in June 2016 revealed the fantastic news that at the point of surgery, all patients had marked tumour reduction or complete disappearance on scans, and around 50% of patients had no melanoma cancer cells left in their tissue.

The protocol has been further developed to investigate the next stage of this promising approach. The Neo-Trio trial, which will commence recruitment in 2017, will test whether treating Stage III melanoma patients with either immunotherapy or immunotherapy plus targeted therapy before and after complete lymph node dissection can prevent Stage IV melanoma from developing. This will be revolutionary if it works.