Not Waiting to Progress; How the COVID-19 Pandemic Nudged Neoadjuvant Therapy for Stage III Locally Advanced Melanoma Patients

Round 1

Reviewer 1 Report

Recently, advances in the detection and characterization of circulating tumour DNA (ctDNA) have finally enabled the introduction of liquid biopsy assays into clinical practice such as cell multigene assays to detect genetic alterations in plasma cell-free DNA (cfDNA). Did you performed these analysis ?. Can you suggest the potential application before and after the NAT and surgery treatment in order to better define therapeutic strategy ??  

Author Response

Many thanks for this interesting comment and suggestion. Unfortunately, we were not able to perform this type of analysis as the technology is not available to us.

Reviewer 2 Report

The authors presented a case series entitled “Not Waiting to Progress; How the COVID-19 Pandemic Nudged Neoadjuvant Therapy For Stage III Locally Advanced Melanoma Patients”. I would like to congratulate the authors for this work.

Abstract:

Starting from the title – The title (as a demonstration and question) should have as answer the conclusion of your research paper. From the abstract conclusion I do not understand how COVID-19 Pandemic Nudged Neoadjuvant Therapy For Stage III Locally Advanced Melanoma Patients.

You have a small number of patients – even though in percentage it sounds better, when you have a small number of patients, it would be great to write the number when you talk about them (for example “83% of patients had ≤1 positive lymph nodes” – this is equal to 5 patients).

Please redefine the conclusion to be in concordance with your title. Remember that the abstract is the most important part in terms of visibility. Is the first part that everyone who read your paper sees.

 

Introduction

Please place your article and research in a context. You begin to talk about some neoadjuvant trials – I suggest to start the introduction with the COVID-19 part and the impact that COVID-19 had had on the melanoma patients.

No bibliography is used into the introduction part. Please take into consideration some aspects related to the neoadjuvant therapy, impact of the COVID-19 on surgery, etc and cite them as numbers into this part and as bibliography entries into the bibliography part.

 

Materials and method:

This part should tell any reader about what was used to do this study: number of patients included, inclusion criteria, exclusion criteria, from which hospital, the years between which the patients were selected, etc.

 

Results:

You should include this part, rephrased, into the materials and method part. “Data from 6 consecutive patients with stage III, unresected melanoma seen during the fourth wave of the COVID-19 pandemic at the Tom Baker Cancer Centre, where OR access was severely restricted, was collected prospectively and reported retrospectively “

 

Regarding this part - 4 of 6 patients included were ≥60 years. Two-thirds were female. 3 patients were BRAF (+); 2 had a V600E mutation and 1 a V600R mutation. No patient had evidence of systemic disease, as per negative PET scans, but 1 patient had lung nodules and a left supraclavicular LN of unknown significance – this information is already presented into Table 1. You can discuss your results into the discussion part.

 

After table 2, you talk about the histopathological assessment of the surgical removed lesions and also about the TRC. Maybe, you can show some photos of this TRCs (Hematoxylin Eosin).

Figure 1 is not necessary – the data is already presented in Table 3.

 

Discussion:

The first 7 paragraphs are a review of the NAT trials and their results. Also, after this, you talk about how the Calgary OR adapted for the COVID conditions, but we do not know what the conditions really are?

In one paragraph, you have 8 citations between [] – 11-18. What are those? What have you cited from these papers?

You should rewrite the discussion part in order to compare your results presented into the results part with other results found in the literature.

 

Conclusion

The COVID-19 pandemic was a time of unprecedented challenges that demanded novel and timely solutions – This is not the conclusion from your presentation – it is a general statement.

The conclusion is not reflecting the title or your results. What has effectively demonstrated your case series or presentation? Which are the particularities of the chosen cases? How can somebody who reads your presentation benefit from it?

 

Others:

Please specify the approval of the ethics committee of the hospital for this study.

 

Bibliography:

You have only 18 bibliography entries. Your title contains COVID-19 and you have only one bibliography entry about COVID. Also, you have a lot of studies regarding trials, but no studies regarding the type of results that you have presented. The COVID-19 pandemic has emerged in March 2020. I am sure that you can find at least 5-10 articles about the axis COVID-19-melanoma-treatment-adaptations.

Author Response

Please see the attached pdf. 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Dear authors, 

Congratulation for the revision made. Well done.