Immunotherapy discontinuation — how, and when? Data from melanoma as a paradigm

Abstract

The optimal duration of therapy in patients receiving immune-checkpoint inhibitors (ICIs) is a new but crucial question that has arisen owing to the observation of durable remissions in >85% of patients with metastatic melanoma who stop receiving an anti-PD-1 antibody after a complete response (CR). Long-term treatment-free remissions have also been seen, albeit much less frequently, in patients receiving ICIs for other forms of cancer who have a CR. Despite these promising observations, the optimal duration of treatment with ICIs remains unknown and requires further investigation in randomized controlled trials. In the absence of prospective data, some general criteria to guide the safe cessation of ICIs can be proposed, at least for patients with melanoma, in whom ICI cessation after a confirmed CR and at least 6 months of treatment is generally deemed safe. In this Perspective, we describe the available data on ICI interruption in patients with melanoma and in those with various other cancers. We also address the patient management implications of stopping ICI therapy.

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Fig. 1: Suggested algorithm to guide ICI cessation in patients with melanoma.

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All authors made a substantial contribution to all aspects of the preparation of the manuscript.

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Correspondence to Caroline Robert.

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C.R. has acted as a consultant of Amgen, Biothera, BMS, MSD, Novartis, Pierre Fabre, Roche, Sanofi and Ultimovacs. A.M. has acted as a consultant of Bayer, BPI, Daichii Sankyo, EISAI, Faron, Genticel, Imaxio, Molecular partners, Onxeo, Pierre Fabre, Pilar partners, Rigontec, Roche and Sanofi/BioNTech. K.F. has served on the advisory boards of AAA, Amgen, Astellas, AstraZeneca, Bayer, Clovis, Curevac, ESSA, Genentech, Janssen, MSD, Orion and Sanofi. C.C. has acted as a consultant of AstraZeneca, BMS, MSD, and Roche. B.B. has conducted research funded by Abbvie, Amgen, AstraZeneca, Biogen, Blueprint Medicines, BMS, Celgene, Eli Lilly, GSK, Ignyta, Ipsen, Merck, MSD, Nektar, Onxeo, Pfizer, Pharma Mar, Sanofi, Spectrum Pharmaceuticals, Takeda and Tiziana Pharm. H.H. and P.R. declare no competing interests.

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Robert, C., Marabelle, A., Herrscher, H. et al. Immunotherapy discontinuation — how, and when? Data from melanoma as a paradigm. Nat Rev Clin Oncol 17, 707–715 (2020). https://doi.org/10.1038/s41571-020-0399-6

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