NEW YORK — Mario Sznol, MD, professor of medicine at Yale Cancer Center, discusses whether single-agent or combination immunotherapy should be used to treat patients with melanoma at HemOnc Today Melanoma and Cutaneous Malignancies.
A retrospective review demonstrated single-agent anti–PD-1 therapies produced durable responses with good tolerability, although combination therapies yielded higher overall response rate and more durable responses, longer PFS and shorter durations of overall therapy.
However, substantially more grade 3 or 4 adverse events occurred with combination therapy.
“The impact and the outcome of sequential therapy — with ipilimumab [Yervoy, Bristol-Myers Squibb] alone or with nivolumab [Opdivo, Bristol-Myers Squibb] after the progression on anti–PD-1 — is not clear, but there is no question that either the combination or ipilimumab do salvage a few patients who progress on anti–PD-1,” Sznol said.
Sznol also discussed biomarkers that can assist in selecting patients who do not need combination therapy, as well as alternate doses and schedules to maintain efficacy and reduce toxicity associated with combinations.
“Biomarkers at this moment have limited utility in this setting,” Sznol said. “Clinical features and clinical judgement are really important to select which patients are unsuitable for the combination therapy. ... Modification of the dose and schedule does hold promise for reducing the toxicity while maintaining efficacy.”
Sznol M, et al. Combination or monotherapy: What’s a clinician to do? Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 24-25, 2017; New York.
Disclosure: Sznol reports consultant roles with Agonox, Alexion, Arbutus, AstraZeneca/MedImmune, Bristol Meyers Squibb, Genentech/Roche, Inovio, Lilly, Merck, Modulate, Nektar, Pfizer, Seatlle Genetics and Theravance; advisory board roles with Adaptimmune, Symphogen, Lycera and Omniox; and stock ownership in Adaptive Biotechnologies, Amphivena and Intensity.