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Poster Display session

256 - The efficacy and safety of rechallenge with an alternative immune checkpoint inhibitor in metastatic malignant melanoma

Date

14 Dec 2018

Session

Poster Display session

Presenters

Ali Abdulnabi Mohamed

Citation

Annals of Oncology (2018) 29 (suppl_10): x17-x23. 10.1093/annonc/mdy486

Authors

A.A. Mohamed, S. Zhang, G. Faust

Author affiliations

  • South East Midlands Oncology Centre, University Hospitals of Leicester NHS Trust, LE1 5WW - Leicester/GB
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Resources

Abstract 256

Background

Immune checkpoint inhibitors (ICIs) have become standard of care in the management of advanced melanoma. While some evidence suggests that rechallenge in the setting of toxicity with prior ICIs is safe, there is rather limited evidence on the efficacy and safety of rechallenge with alternative ICI in the context of disease progression on initial ICI.

Methods

We retrospectively analysed all patients with advanced melanoma who received ICIs between March 2016 and August 2017 at our centre. We used i) RECIST criteria to estimate objective overall response rate (ORR) & ii) Kaplan-Meier method to calculate the progression-free survival (PFS) and overall survival (OS).

Results

Overall, 60 melanoma patients received ICIs, 31 patients discontinued initial ICI due to toxicity (N = 7) or disease progression (N = 24). 17 patients (54.8%) were rechallenged with an alternative ICI and three (17.6%) were rechallenged again with a third ICI. Of the 17 rechallenged patients, their initial treatment was discontinued due to either disease progression (14/17, 82%) or toxicity (3/17, 18%). The types of ICIs in rechallenged patients were as follows: first ICI; ipilimumab [anti-CTLA4] (9), combination ipilimumab and nivolumab [anti-PD-1] (1) and pembrolizumab [anti-PD-1] (7) and subsequent ICI; pembrolizumab (10), ipilimumab (6) and nivolumab (1). The three patients rechallenged for a second time all received nivolumab. The ORR in rechallenged patients was 23.5% vs 51.2% in the non-rechallanged patients. Rates of adverse events were not significantly different compared to first ICIs (Grade 3 irAE: 17.5% vs 23.5%). The median PFS and OS of rechallenged patients were 20 months [95% CI: 3.9-36.0] and 29.4 months [95% CI: 14.6-44.3] respectively, compared to 4 months [95% CI: 1.1-6.8] and 8.4 months [95% CI: 1.9-14.8] for patients who discontinued but not rechallenged. The authors note that comparing these groups should be interpreted with caution as they may constitute different patient cohorts.

Conclusions

In the setting of disease progression or toxicity in the management of advanced melanoma with an initial ICI, rechallenge with alternative ICIs shows some ORR and reasonable PFS and OS. This strategy maybe a viable plan for selected patients.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Guy Faust.

Funding

Has not received any funding.

Disclosure

G. Faust: Educational sponsorship to conferences, advisory board: MSD, BMS. All other authors have declared no conflicts of interest.

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