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VIDEO: Combination immunotherapy promising, but questions remain

HemOnc Today melanoma section editor Sanjiv S. Agarwala, MD, chief of medical oncology and hematology for St. Luke’s University Hospital & Health Network, Bethlehem, Pa., discusses the emerging role of combining anti-CTLA-4 and anti-PD-1 immunotherapies vs. anti-PD-1 single-agent monotherapy.

Agarwala outlines dosing for the two anti-PD-1 therapies – nivolumab (Opdivo, Bristol-Myers Squibb) and pembrolizumab (Keytruda, Merck) — that have replaced CTLA-4 inhibitor ipilimumab (Yervoy, Bristol-Myers Squibb) as front-line therapy for metastatic melanoma, then reviews data from the CheckMate 067 trial.

“The combination of nivolumab and ipilimumab — anti-PD-1 and anti-CTLA-4 — compared to anti-PD-1 alone — nivolumab, and anti-CTLA-4 alone, — ipilimumab, showed a superiority in PFS,” he said. 

Agarwala highlights the potential toxicity from this combination, emphasizing that adverse events need to be factored into every clinician’s decision-making process. He also underscores that the yet-unknown OS data with the combination is critical.

Lastly, he touches on the patient characteristics clinicians must consider in determining who are candidates and what areas require vigilance.

“For the community oncologist, putting the combination together will be a challenge … but not an insurmountable challenge,” Agarwala said.

HemOnc Today melanoma section editor Sanjiv S. Agarwala, MD, chief of medical oncology and hematology for St. Luke’s University Hospital & Health Network, Bethlehem, Pa., discusses the emerging role of combining anti-CTLA-4 and anti-PD-1 immunotherapies vs. anti-PD-1 single-agent monotherapy.

Agarwala outlines dosing for the two anti-PD-1 therapies – nivolumab (Opdivo, Bristol-Myers Squibb) and pembrolizumab (Keytruda, Merck) — that have replaced CTLA-4 inhibitor ipilimumab (Yervoy, Bristol-Myers Squibb) as front-line therapy for metastatic melanoma, then reviews data from the CheckMate 067 trial.

“The combination of nivolumab and ipilimumab — anti-PD-1 and anti-CTLA-4 — compared to anti-PD-1 alone — nivolumab, and anti-CTLA-4 alone, — ipilimumab, showed a superiority in PFS,” he said. 

Agarwala highlights the potential toxicity from this combination, emphasizing that adverse events need to be factored into every clinician’s decision-making process. He also underscores that the yet-unknown OS data with the combination is critical.

Lastly, he touches on the patient characteristics clinicians must consider in determining who are candidates and what areas require vigilance.

“For the community oncologist, putting the combination together will be a challenge … but not an insurmountable challenge,” Agarwala said.

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