On March 28, 2025 SkylineDx, an innovative diagnostics company specializing in the research and development of molecular diagnostics for oncology , inflammatory and infectious diseases, proudly reported Dr. Tina Hieken, a surgical oncologist at Mayo Clinic and one of the principal investigators of the groundbreaking MERLIN_001 study, will present new data at the 2025 Society of Surgical Oncology (SSO) Annual Meeting (Press release, SkylineDx, MAR 28, 2025, View Source [SID1234651592]). Dr. Hieken’s presentation, titled Prospective Multicenter Evaluation (MERLIN_001 Trial) of a Clinicopathologic and Gene Expression Profile Test to Predict Sentinel Node Status in T1-T3 cN0 Melanoma, will showcase the final results of this pivotal study, which demonstrates the accuracy of the Merlin CP-GEP test in predicting sentinel lymph node (SLN) metastases in melanoma patients.
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The MERLIN_001 trial is the largest prospective, blinded study, to evaluate the Merlin CP-GEP test, which is the only commercially avialable GEP test that combines clinical, pathological, and gene expression data into a single algorithm to predict SLN positivity. The study was conducted at 9 renowned US hospitals, which are also top-ranking oncology academic centers. The study’s findings validate the test’s superior predictive accuracy compared to traditional clinical and pathological factors, which currently guide sentinel lymph node biopsy (SLNB) decisions in melanoma.
A total of 1,802 patients were included for whom SLN biopsy material was available. CP-GEP achieved an assay success rate of 97.7%, thus a total of 1,761 patients could be enrolled. The National Comprehensive Cancer Network (NCCN) clinical guidelines recommend SLNB surgery for patients with >10% risk of nodal metastases. This cohort had a 17.6% overall SLNB positivity rate, suggesting effective referral of patients based on current factors. However, 82.4% of patients had a negative sentinel node suggesting no therapeutic benefit from the sentinel node operation.
How did Merlin CP-GEP test provide more precise risk stratification, allowing physicians to further optimize SLNB referral decisions and personalize treatment plans? Key findings from the MERLIN_001 study:
In this cohort a total of 31 T1a patients with adverse features were referred for SLNB surgery. Merlin identified 80.6% as Low Risk for nodal metastases at a negative predictive value (NPV) of 100%. These patients could consider forgoing SLNB surgery as their risk of nodal metastases is close to 0%. Six patients were identified as Merlin High Risk. Their risk of metastases was with 16.7% well above the >10% guideline threshold, therefore these patients should be referred for surgery.
Among the 479 T1b patients, Merlin test identified 67.6% as Low Risk for nodal metastases with a 94.8% NPV. These patients could consider forgoing SLNB surgery as their risk of metastases is close to 5%. Additionally, T1b patients with a Merlin High Risk label had a 16.1% SLNB positivity rate and should be referred for surgery.
The study’s findings are particularly significant for T2a melanoma patients. This patient subgroup had an SLN positivity rate of 15.5%. Merlin test identified 36.6% as Low Risk at an NPV of 91.9%, reducing their metastatic risk below the 10% threshold for SLNB surgery recommendation. Reclassification of these T2a patients gives them access to more personalized treatment options.
The Merlin CP-GEP test also demonstrated exceptional performance in other subgroups, particularly in head and neck melanoma patients. SLNB surgery in this group poses unique challenges due to complex lymphatic drainage and vital anatomical structures. Merlin test identified 43.3% as Low Risk for nodal metastases with an NPV of 95.1%. These patients could consider forgoing SLNB surgery as their risk of metastases is below 5%.
"The MERLIN_001 study provides a transformative approach to melanoma risk assessment, ensuring that we can better personalize care for our patients. The test not only refines risk stratification but also addresses critical subgroups, such as head and neck melanoma patients and elderly individuals, who often face complex treatment decisions. By leveraging this groundbreaking tool, we can confidently guide SLNB recommendations and optimizing patient outcomes," said Dr. Tina Hieken.
"The MERLIN_001 study results are a breakthrough in melanoma care," said Dharminder Chahal, CEO of SkylineDx. "As the only company to have conducted this large, prospective, blinded trial of the Merlin CP-GEP test in collaboration with esteemed academic institutions in the U.S., we are committed to empowering clinicians with a rigorously validated test backed by high-quality evidence, ensuring patients receive the most informed care possible ."
The MERLIN_001 study represents a major milestone in melanoma research, with the potential to enhance clinical decision-making and improve patient outcomes. By offering more accurate risk assessments, the Merlin CP-GEP test empowers healthcare providers to tailor treatment plans to the specific needs of melanoma patients.
About the advanced cutaneous melanoma GEP test (Merlin CP-GEP test)
CP-GEP is a non-invasive prediction model for cutaneous melanoma patients and is the only commercially available GEP test that combines clinicopathologic (CP) variables with gene expression profiling (GEP) into a single integrated algorithm. This CP-GEP model is also the only GEP test that provides a binary stratification of all patients based on being High or Low Risk for metastasis and thereby assign them to the appropriate surgical action categories as listed in evidence-based cancer treatment, prevention and screening guidelines. The advanced generation CP-GEP model was developed by Mayo Clinic and SkylineDx BV and is the latest commercially launched GEP test, which has been clinically validated in multiple studies on a global basis. More information (including references) may be obtained at www.falconprogram.com and www.merlinmelanomatest.com. The test has been launched in the United States and Europe as Merlin test. SkylineDx collaborates with diagnostic service providers globally to bring this test to market and increase patient access.