Abstract 3632
Background
Combination IPI+PD1 immunotherapy has a high initial response rate, but patients can subsequently progress. The best management of this acquired resistance is unknown. We sought to explore the efficacy and safety of rechallenge IPI+PD1 in this setting.
Methods
Retrospective data from four melanoma centres were reviewed. Demographics, disease characteristics, initial and rechallenge treatment efficacy and toxicity were examined.
Results
15 patients (pt) were identified: 60% male, median age 51y, 40% BRAF mutant. 14 pt received IPI+PD1 as 1st line of treatment, 1 received prior BRAFi+MEKi. 9 pt received ipilimumab (I) 3mg/Kg and nivolumab (N) 1mg/kg (I3N1), 5 received I 1mg/kg and pembrolizumab (P) 2mg/kg, 1 patient I 100mg q12w/P200mg q3w, with a median 4 cycles of I. 1 pt had CR, 10 had PR, and 4 prolonged SD (>6 months) to initial treatment. 7 pt (47%) developed significant irAE (4 hepatitis, 2 colitis, 1 pneumonitis), of which 6 (85%) ceased IPI + PD1 and only 1 pt continued PD1 alone. Median time to progression (TTP1) was 11 months (range 5-31 months). After progression, 5 (33%) had no intervening systemic therapy prior to rechallenge IPI+PD1 (of which 3 progressed on while receiving maintenance PD1), 5 had BRAFi/MEKi (33%), 2 (13%) had anti-PD1 monotherapy, 2 (13%) had investigational immunotherapy agents on a trial, and 1 pt had DTIC. At rechallenge, 13 pt received I3N1, 1pt I1N3 and 1 pt I3q12w + N1q2w, with a median 2 cycles of I. Only 1 pt had PR, 1 had SD, while 13 (87%) had PD, with mPFS2 only 2.7 mo (95% CI 2- NA). OS from rechallenge was 7.5 mo (95% CI 6.7- NA). All 7 pt with prior treatment-limiting irAE had the same irAE recur, except for 1 pt who died one week after re-exposure of PD, and 1 pt with prior pneumonitis who remained on 10mg prednisone without recurrence.
Conclusions
Rechallenge with IPI + PD1 appears to have little efficacy in those with acquired resistance and prior toxicity often recurs. An expanded multi-institutional analysis is under way.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A. Hepner: Advisory / Consultancy: Novartis; Travel / Accommodation / Expenses: Roche. M.S. Carlino: Advisory / Consultancy: BMS; Advisory / Consultancy: Merck; Advisory / Consultancy: MSD; Advisory / Consultancy: Novartis; Advisory / Consultancy: AMGEN; Advisory / Consultancy: Pierre Fabre; Advisory / Consultancy: Roche. D.B. Johnson: Advisory / Consultancy: Array Biopharma; Advisory / Consultancy: BMS; Advisory / Consultancy: Incyte; Advisory / Consultancy: Merck; Advisory / Consultancy: Novartis; Research grant / Funding (institution): BMS; Research grant / Funding (institution): Incyte; Travel / Accommodation / Expenses: Genentech. O.A. Michielin: Advisory / Consultancy: BMS; Advisory / Consultancy: MSD; Research grant / Funding (institution): BMS; Research grant / Funding (institution): MSD. G.V. Long: Advisory / Consultancy: Aduro; Advisory / Consultancy: Amgen; Advisory / Consultancy: BMS; Advisory / Consultancy: Merck; Advisory / Consultancy: MSD; Advisory / Consultancy: Mass-Array; Advisory / Consultancy: Novartis; Advisory / Consultancy: Pierre Fabre; Advisory / Consultancy: Roche. A.M. Menzies: Advisory / Consultancy: BMS; Advisory / Consultancy: MSD; Advisory / Consultancy: Novartis; Advisory / Consultancy: Roche; Advisory / Consultancy: Pierre Fabre. All other authors have declared no conflicts of interest.
Resources from the same session
5579 - Quality of informed consent in clinical trials patients
Presenter: Gianluca Catania
Session: Poster Display session 3
Resources:
Abstract
5147 - Patient's rights: Where do we stand?
Presenter: Maja Kozuh
Session: Poster Display session 3
Resources:
Abstract
1279 - The oncology nurse coordinator’s role in a digestive oncology department: Impact on patient and hospital
Presenter: Fouad Awada
Session: Poster Display session 3
Resources:
Abstract
1670 - Nursing model for a breast cancer unit at the Catalan Institute of Oncology
Presenter: Ana Rodriguez-ortega
Session: Poster Display session 3
Resources:
Abstract
3936 - Role of cancer nurse in the prevention and control of acute deterioration for oncohematologic patient
Presenter: Raquel Azor Portolés
Session: Poster Display session 3
Resources:
Abstract
2789 - Standardized nursing care in the department of radiotherapy of a network of cancer centres
Presenter: José Delgado
Session: Poster Display session 3
Resources:
Abstract
4482 - Exploring anxiety, depression and quality of life of ambulatory cancer patients during chemotherapy.
Presenter: Theodoula Adamakidou
Session: Poster Display session 3
Resources:
Abstract
3075 - Implementing a Cancer Survivorship Program for Individuals with Recurrent Breast Cancer
Presenter: Darcy Burbage
Session: Poster Display session 3
Resources:
Abstract
3869 - The perceptions of parents/guardians regarding their child/adolescent’s experience of reflexology or non-specific foot massage The perceptions of parents/guardians regarding their child/adolescents experience of reflexology or non-specific foot massage
Presenter: Patricia Fox
Session: Poster Display session 3
Resources:
Abstract
4064 - Quality of life in survivors of adult haematological malignancies
Presenter: Anita Immanuel
Session: Poster Display session 3
Resources:
Abstract