Cancer Treatment Today

Forty to 60% of patients with advanced or metastatic melanoma respond to first-line immune checkpoint inhibitors (ICI) and half of all patients in the metastatic setting eventually progress.Zremba evaluated the latest long-term data from clinical trials. It also considered data from recent retrospective studies, as these address important questions for clinical practice. ‘Retreatment’ defined as ‘repeated treatment with the same therapeutic class following relapse after adjuvant treatment has ended’ and showed activity in selected patients with recurrence after regular completion of adjuvant PD-1 treatment. In melanoma patients with adjuvant PD-1 monotherapy who recur during adjuvant treatment, further treatment with PD-1 monotherapy seems to have no clinical utility, It concluded that his approach provided some benefit, but indicating the need for a therapy switch or escalation in these patients. f possible, ‘escalation’ (PD-1 inhibitors combined with additional agents) should be preferred to PD-1 inhibitor monotherapy rechallenge as higher response rates were demonstrated. The combination of PD-1 plus CTLA-4 was found to be more effective but not more toxic than CTLA-4 alone. Otehr studies showed similar results. For example, Sadrolashrafi found that
On the other hand, immune checkpoint inhibitor (ICI) retreatment in advanced melanoma is used in clinical practice, but there is a lack of evidence to support it, according to research presented at the NCCN 2023 Annual Conference.

Zaremba A, Eggermont AMM, Robert C, Dummer R, Ugurel S, Livingstone E, Ascierto PA, Long GV, Schadendorf D, Zimmer L. The concepts of rechallenge and retreatment with immune checkpoint blockade in melanoma patients. Eur J Cancer. 2021 Sep;155:268-280.

Kaviyon Sadrolashrafi, Wolfram Samlowski, Retreatment of Patients With Metastatic Cutaneous Melanoma Who Relapse After Elective Checkpoint Inhibitor Discontinuation After a Complete Remission, The Oncologist, Volume 28, Issue 5, May 2023, Pages e270–e275,

Olson D, Gastman B, Rowell A, et al. Immune checkpoint inhibitor (ICI) treatment after progression on anti-PD-1 therapy in advanced melanoma: A systematic review of the literature. NCCN 2023. March 31-April 2, 2023. Abstract HSR23-110.