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Efficacy and toxicity of rechallenge with combination immune checkpoint blockade in metastatic melanoma: a case series

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Abstract

Background

The efficacy and potential toxicity of rechallenge with combination ipilimumab and nivolumab has not been described. Retreatment of patients with immune checkpoint inhibitors in the setting of prior significant toxicity lacks evidence-based guidance.

Methods

We present the first three, consecutive patients who received re-treatment with combination ipilimumab and nivolumab for metastatic melanoma managed at our institution.

Results

Rechallenge with combination ipilimumab and nivolumab in the setting of prior grade 3 toxicity with initial combination therapy is feasible, and responses are seen. We highlight the fact that grade 3 toxicity is likely to recur, but if so, can be manageable.

Conclusions

Retreatment with ipi + nivo may be considered an option in carefully selected, well-informed patients. More research is required to delineate the benefits and risks with this approach.

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Abbreviations

ALT:

Alanine aminotransferase

CT:

Computed tomography

ECOG:

Eastern Co-operative Group

FDG:

2-Fluoro-2-deoxy-d-glucose

Ipi + nivo:

Ipilimumab and nivolumab

irAE:

Immune-related adverse event

MMF:

Mycophenolate mofetil

MRI:

Magnetic resonance imaging

PET-CT:

Positron emission tomography-computed tomography

RECIST:

Response evaluation criteria in solid tumours

ULN:

Upper limit of normal

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Author information

Author notes

  1. James Larkin

    Present address: Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK

Authors and Affiliations

  1. Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK

    Lavinia Spain, Gerard Walls, Samra Turajlic, Martin Gore & James Larkin

  2. Radiology Unit, Royal Marsden NHS Foundation Trust, London, UK

    Christina Messiou

  3. The Francis Crick Institute, London, UK

    Samra Turajlic

Authors
  1. Lavinia Spain
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  2. Gerard Walls
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  3. Christina Messiou
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  4. Samra Turajlic
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  5. Martin Gore
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  6. James Larkin
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Corresponding author

Correspondence to James Larkin.

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Conflict of interest

James Larkin is a non-remunerated consultant for Novartis, Pfizer, Bristol Myers Squibb (BMS), Merck Sharp & Dohme (MSD), Roche/Genentech, Glasko Smith Kline (GSK) and Eisai and receives institutional research support from Pfizer, BMS, Novartis and MSD. James Larkin and Martin Gore are supported by the National Institute for Health Research Royal Marsden Hospital and Institute of Cancer Research Biomedical Research Centre (NIHR RMH/ICR BRC). Samra Turajlic is a Cancer Research UK (CRUK) Clinician Scientist and is funded by CRUK (Grant Ref. C50947/A18176) and the NIHR RMH/ICR BRC (Grant Ref. A109). The remaining authors have declared no conflicts of interest.

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We are very grateful to our patients who gave consent for their clinical details to be included in this paper.

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Spain, L., Walls, G., Messiou, C. et al. Efficacy and toxicity of rechallenge with combination immune checkpoint blockade in metastatic melanoma: a case series. Cancer Immunol Immunother 66, 113–117 (2017). https://doi.org/10.1007/s00262-016-1926-2

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  • DOI: https://doi.org/10.1007/s00262-016-1926-2

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