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Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment?

Background: Immune checkpoint inhibition (ICI) has significantly improved the survival of metastatic melanoma (MM) with a significant proportion of patients obtaining long-lasting responses. However, ICI also exposes patients to new, heavy, and sometimes irreversible toxicities. Thus, identifying th...

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Autores principales: De Risi, Ivana, Sciacovelli, Angela Monica, Guida, Michele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9599026/
https://www.ncbi.nlm.nih.gov/pubmed/36289687
http://dx.doi.org/10.3390/biomedicines10102424
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author De Risi, Ivana
Sciacovelli, Angela Monica
Guida, Michele
author_facet De Risi, Ivana
Sciacovelli, Angela Monica
Guida, Michele
author_sort De Risi, Ivana
collection PubMed
description Background: Immune checkpoint inhibition (ICI) has significantly improved the survival of metastatic melanoma (MM) with a significant proportion of patients obtaining long-lasting responses. However, ICI also exposes patients to new, heavy, and sometimes irreversible toxicities. Thus, identifying the minimal amount of treatment time is extremely urgent. Methods: We researched English peer-reviewed literature from electronic databases (MEDLINE and PubMed) until July 2022 with the aim of evaluating the clinical outcomes after the cessation of ICI therapy due to elective study plans, clinician–patient sharing, and adverse events. Results: Although most of the data are from retrospective studies, considering that most patients with major responses maintain it after treatment cessation, it is proposed that for complete response (CR)/near CR, a further six months of therapy after best response may be considered enough. For partial response (PR) or stable disease (SD), treatment must be continued for at least 2 years and, in some cases, indefinitely, based on residual disease, the patient’s will, and the toxic profile. Of note, in spite of the best response, 25–30% of patients relapsed, and, when retreated, responded far less than in front-line treatment. Conclusions: Most of the data being from retrospective and heterogeneous experiences, their grade of evidence is limited and no consensus has been reached on the optimal treatment duration. Controlled prospective studies are needed.
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spelling pubmed-95990262022-10-27 Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment? De Risi, Ivana Sciacovelli, Angela Monica Guida, Michele Biomedicines Systematic Review Background: Immune checkpoint inhibition (ICI) has significantly improved the survival of metastatic melanoma (MM) with a significant proportion of patients obtaining long-lasting responses. However, ICI also exposes patients to new, heavy, and sometimes irreversible toxicities. Thus, identifying the minimal amount of treatment time is extremely urgent. Methods: We researched English peer-reviewed literature from electronic databases (MEDLINE and PubMed) until July 2022 with the aim of evaluating the clinical outcomes after the cessation of ICI therapy due to elective study plans, clinician–patient sharing, and adverse events. Results: Although most of the data are from retrospective studies, considering that most patients with major responses maintain it after treatment cessation, it is proposed that for complete response (CR)/near CR, a further six months of therapy after best response may be considered enough. For partial response (PR) or stable disease (SD), treatment must be continued for at least 2 years and, in some cases, indefinitely, based on residual disease, the patient’s will, and the toxic profile. Of note, in spite of the best response, 25–30% of patients relapsed, and, when retreated, responded far less than in front-line treatment. Conclusions: Most of the data being from retrospective and heterogeneous experiences, their grade of evidence is limited and no consensus has been reached on the optimal treatment duration. Controlled prospective studies are needed. MDPI 2022-09-28 /pmc/articles/PMC9599026/ /pubmed/36289687 http://dx.doi.org/10.3390/biomedicines10102424 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
De Risi, Ivana
Sciacovelli, Angela Monica
Guida, Michele
Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment?
title Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment?
title_full Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment?
title_fullStr Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment?
title_full_unstemmed Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment?
title_short Checkpoint Inhibitors Immunotherapy in Metastatic Melanoma: When to Stop Treatment?
title_sort checkpoint inhibitors immunotherapy in metastatic melanoma: when to stop treatment?
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9599026/
https://www.ncbi.nlm.nih.gov/pubmed/36289687
http://dx.doi.org/10.3390/biomedicines10102424
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