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
3073 - 1 patient 3 different advance Ca nurse’s roles: symptom management&continuum care through a joint approach in a clinical case
Presenter: Catarina Almeida
Session: Poster Display session 3
Resources:
Abstract
4527 - Identification of malnutrition risk factors in patients with cancer in the first nursing visit
Presenter: Amaia Valverde
Session: Poster Display session 3
Resources:
Abstract
2904 - Engaging Cancer Survivors, Healthcare Providers and Advocates in The Development of a Colorectal Cancer Survivorship Information Resource: A Participatory Action Research Study
Presenter: Amanda Drury
Session: Poster Display session 3
Resources:
Abstract
3435 - Medical nurses’ experiences of the care-needs of adult patients with a primary brain tumour
Presenter: Jamila Mohammed
Session: Poster Display session 3
Resources:
Abstract
857 - Feasibility and acceptability of a mHealth intervention to increase colonoscopy uptake among Chinese first-degree relatives: a pilot cluster randomized controlled trial
Presenter: Yang Bai
Session: Poster Display session 3
Resources:
Abstract
1087 - Cancer patient participation and compliance in microbiome sample collection: an oncology research nurse’s experience
Presenter: Julie Malo
Session: Poster Display session 3
Resources:
Abstract
2783 - Implementing Digital Individual Care plans for Patients with Head and Neck cancer- Challenges and opportunities
Presenter: Helena Ullgren
Session: Poster Display session 3
Resources:
Abstract
1152 - The Effect of the Short-term and Long-term Compassion Fatigue Resiliency Program on the Quality of Life, Perceived Stress and Psychological Resilience of Oncology-Hematology Nurses
Presenter: Tugba Pehlivan
Session: Poster Display session 3
Resources:
Abstract
1172 - Competing risk analyses of overall survival and cancer-specific survival in patients with orbital rhabdomyosarcoma after surgery: a large cohort study
Presenter: Yu Zhang
Session: Poster Display session 3
Resources:
Abstract
5949 - Communication of genetic information to family members in hereditary cancers and healthcare providers’ role
Presenter: Carla Pedrazzani
Session: Poster Display session 3
Resources:
Abstract