Journal
EUROPEAN JOURNAL OF CANCER
Volume 65, Issue -, Pages 182-184Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejca.2016.07.003
Keywords
Ipilimumab; Pembrolizumab; Anti-PD-1; Melanoma; Combined immunotherapy
Categories
Funding
- Novartis
- Amgen
- BMS
- Roche
- Celgene
- GSK
- MedImmune
- MelaSciences
- Merck Serono
- Oncosec
- Eisai
- MSD
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With the wide use of anti-PD-1 therapy, an increasing number of patients progress under treatment. Combined immunotherapy with anti-CTLA-4 and anti-PD-1 antibodies induces higher response rates as first-line treatment in comparison to single-agent therapy, however, with substantial toxicity since the combination of ipilimumab (3 mg/kg) and nivolumab (1 mg/kg) induced 55% grade 3/4 treatment-related adverse events and treatment discontinuation rates of 39%. In this case series, we investigated the efficacy and toxicity of the combined immunotherapy with low-dose ipilimumab (1 mg/kg) plus pembrolizumab (2 mg/kg) in patients with metastatic melanoma with progressive disease under sequential monotherapy with both agents. All patients had received at least three lines of treatment, 78% of patients were M1c, and 67% had brain metastases. Stable disease was observed in 3 out of 9 patients with a median overall survival of 8 months after double checkpoint inhibition. No treatment-related grade 3/4 adverse events occurred, and none of the patients needed to discontinue the treatment due to toxicity. Further trials are needed to investigate combined immunotherapy as rescue treatment in heavily pre-treated melanoma patients to find optimal dosage in regard to outcome and toxicity. (C) 2016 Elsevier Ltd. All rights reserved.
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