Lavinia Spain1, Gerard Walls1, Christina Messiou2, Samra Turajlic1,3, Martin Gore1, James Larkin4,5. 1. Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK. 2. Radiology Unit, Royal Marsden NHS Foundation Trust, London, UK. 3. The Francis Crick Institute, London, UK. 4. Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK. james.larkin@rmh.nhs.uk. 5. Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK. james.larkin@rmh.nhs.uk.
Abstract
BACKGROUND: The efficacy and potential toxicity of rechallenge with combination ipilimumab and nivolumab has not been described. Retreatment of patients with immune checkpoint inhibitors in the setting of prior significant toxicity lacks evidence-based guidance. METHODS: We present the first three, consecutive patients who received re-treatment with combination ipilimumab and nivolumab for metastatic melanoma managed at our institution. RESULTS: Rechallenge with combination ipilimumab and nivolumab in the setting of prior grade 3 toxicity with initial combination therapy is feasible, and responses are seen. We highlight the fact that grade 3 toxicity is likely to recur, but if so, can be manageable. CONCLUSIONS: Retreatment with ipi + nivo may be considered an option in carefully selected, well-informed patients. More research is required to delineate the benefits and risks with this approach.
BACKGROUND: The efficacy and potential toxicity of rechallenge with combination ipilimumab and nivolumab has not been described. Retreatment of patients with immune checkpoint inhibitors in the setting of prior significant toxicity lacks evidence-based guidance. METHODS: We present the first three, consecutive patients who received re-treatment with combination ipilimumab and nivolumab for metastatic melanoma managed at our institution. RESULTS: Rechallenge with combination ipilimumab and nivolumab in the setting of prior grade 3 toxicity with initial combination therapy is feasible, and responses are seen. We highlight the fact that grade 3 toxicity is likely to recur, but if so, can be manageable. CONCLUSIONS: Retreatment with ipi + nivo may be considered an option in carefully selected, well-informed patients. More research is required to delineate the benefits and risks with this approach.
Authors: Nethanel Asher; Edith M Marom; Guy Ben-Betzalel; Erez Nissim Baruch; Yael Steinberg-Silman; Jacob Schachter; Ronnie Shapira-Frommer; Gal Markel Journal: Oncologist Date: 2019-02-18
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