NEW YORK — Michael A. Postow, MD, medical oncologist at Memorial Sloan Kettering Cancer Center, addressed the use of immune checkpoint inhibitors at HemOnc Today Melanoma and Cutaneous Malignancies.
He focused his discussion of the most effective treatment options around a case presentation of a 52-year-old man with BRAF wild-type esophageal melanoma.
Factors that may affect an oncologist’s decision between single-agent PD-1 therapy and combination therapy include comorbidities, contraindications to steroids or immunosuppression, pace and disease burden, and patient communications with health care providers.
“Pace and disease burden may be the most important factor [in choosing being single-agent and combination therapy],” Postow said. “If you have a patient who is progressing very quickly, and you do not get a response right away, they may not even be a candidate for second-line treatment. That would be a patient for whom I would favor the combination initially.”
If a patient has a BRAF mutation, clinicians must decide the appropriate sequence of targeted therapies and immunotherapies.
“There is so much equipoise in terms of BRAF/MEK inhibition or PD-1 antibodies and what to do,” Postow said. “That is the subject of ongoing randomized clinical trials that are really for the first time testing combinations of targeted therapies vs. combinations of immunotherapy. The question still really is, do you combine or do you sequence these types of approaches?”
Postow MA, et al. Immune checkpoint inhibitors: What’s new in combination and sequencing? Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 24-25, 2017; New York.
Disclosure: Postow reports advisory roles with Amgen, Bristol-Myers Squibb, Caladrius and Novartis; research support from Bristol Myers Squibb; and honoraria from Bristol-Myers Squibb and Merck.