Ipilimumab, BRAF/MEK Inhibitors Are Active in Patients With Resected Melanoma Who Recurred on Adjuvant Anti–PD-1

When it comes to optimal management of patients who had distant recurrence after receiving adjuvant anti–PD-1 monoclonal antibodies for high-risk resected melanoma, some patients may not respond to subsequent anti–PD-1 treatment and should thus change to other types of medications, suggested the results of a study presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Illinois.1

In this retrospective study, researchers looked at 136 patients across 16 international melanoma centers whose disease recurred after receiving adjuvant anti-PD-1 monoclonal antibodies for resected stage III/IV cutaneous melanoma. Of these patients, 97 (71%) recurred during adjuvant anti–PD-1 monoclonal antibodies treatment and 40 (29%) recurred after treatment cessation; specifically, 25 patients had to stop receiving treatment early for reasons related to toxicity after about 3 months, 14 stopped after completing 1 year of treatment, and 1 person withdrew consent after 1 month. Median time from therapy onset to recurrence was 4.6 months (IQR 2.7-8.5).

The researchers found that, at initial recurrence, 78 (57%) patients had distant disease — a group that included 22 patients with both distant and locoregional disease. Fifty-nine patients (43%) had locoregional disease only. Of the 59 patients who initially had local recurrence, 22 (37%) eventually went on to develop distant disease. Moreover, 26 (19% of the total number) patients died.

The researchers were able to evaluate responses to systemic therapy for distant recurrence, either first or subsequent, in 92 of 109 patients. Of the 92 patients, 71 initially had disease recurrence while they were receiving adjuvant anti–PD-1 treatment, and 21 had disease recurrence off treatment.

Among those who had their disease recur during treatment with PD-1 inhibitors, 8 of 33 patients (24%) subsequently responded to ipilimumab-based therapy, either alone or in combination with PD-1 blockade.

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Moreover, 18 of 23 patients (78%) responded to BRAF/MEKi. Only 1 of 9 patients (11%) responded to anti–PD-1 with a novel agent, and no patients responded to anti–PD-1 alone.

This article originally appeared on Cancer Therapy Advisor