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Timing of Immunotherapy Discontinuation Remains Challenging in Melanoma

Thomas Marron, MD
Published Online:7:25 PM, Tue November 19, 2019

Thomas Marron, MD, an assistant professor of medicine, hematology and medical oncology at Mount Sinai Hospital, discusses the rationale for investigating immunotherapy discontinuation in patients with melanoma.

Marron and colleagues designed a clinical trial to address the challenge of when to stop immunotherapy. This is a hurdle in melanoma, as well as other histologies, because immunotherapies are very effective and more patients are achieving either durable remissions or disease stability. However, patients often remain on these treatments indefinitely.

In the case of nivolumab (Opdivo), the immunotherapeutic agent is given indefinitely, while pembrolizumab (Keytruda) is given for 2 years to patients with melanoma. Although these agents are inching researchers closer towards potentially curing the disease, it is unknown how much of the agent should be used or if physicians can be giving significantly less.

These agents cost a small fortune, Marron notes, which leads to financial toxicity in both the patient and society. Additionally, the longer patients receive these drugs, the more likely they are to develop immune-related toxicities. If the drugs can be discontinued earlier in patients with melanoma, the risk of financial and physical toxicity associated with that over-use may also decrease.
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