Adjuvant Ipi vs. Nivo

[Anonymous]

Hi Everyone!

I just wanted to see for those of you that may have had a patient on high dose Ipi at the time of the FDA approval of Nivo, what have you been doing with those patients as far as their treatment?

Thanks,
Lisa

[Anonymous]

Hi Lisa,
This is a really interesting question. We have not run into this specific scenario at our institution, but if we did encounter it I think our plan would be individualized based on patient tolerance to high dose ipilimumab. For instance, if the patient was tolerating ipi very well with few immune related adverse events, then I think we would complete the 4 doses of high dose ipi. If having mild immune related adverse events, then adjuvant nivo would be considered once those issues improved. If the immune related adverse events were more severe, I suspect we would stop adjuvant therapy altogether and observe the patient very closely for recurrence.
I would love to hear what others think or are doing in this situation.
Virginia

[Anonymous]

Hi Lisa-
We had very few patients on adjuvant ipi due to the high risk of toxicity. The few we did have on, had completed the 4 doses.

Had we had any patients- I have to say our actions would mimic Virginia’s.

[Mandi Murph]

HI Ladies,

Indeed a very interesting question and conversation. We’ve have had a small number of patients on adjuvant ipi, dependieng upon where patients were at with their therapy determined how we then proceeded. Most completed their 4 induction phases with ipilimumab followed by a year on maintenance and the few who remain more recently have been transitioned to nivo for maintenance. Most new adjuvant patients who don’t either qualify for or want to participate in a clincial trial consider adjuvant therapy with nivolumab.

Just as an aside note, so many changes are occurring so rapidly with dosing and administration that checking the manufacturers website for update PI/ admin info can be helpful.

[Anonymous]

It is great to hear how others are managing the adjuvant nivo situation.

I have a different question. We have a few patients with ocular melanoma on immunotherapy. I would not have predicted that they would do well, but so far there disease has stabilized (and it was growing prior to therapy). What is your practice regarding treating ocular or mucosal melanomas with immunotherapy?

[Anonymous]

Funny you should bring that up Virginia. We have seen similar scenarios where patients with ocular melanoma, if anything, are having stabilization of their disease and this seems to be ongoing. Unfortunately the majority of those patients (in my experience) do ultimately progress, but when combined with other liver directed therapies, (such as SIRT, etc) some do fairly well. I agree that it is better than I would have expected. I have not seen as beneficial results with vaginal melanomas. I’m not sure you’re experience has been.

[Anonymous]

Interesting conversation. We have been trying to do multimodality therapy with our ocular patients (i.e SBRT, ablation) in combo with ICI therapy. We’ve had a bit more success with this manner then just ICI alone.

In terms of our mucosal patients, we seem to have had better results from dual ICI therapy in this group, although to a lower extent than we see in the cutaneous population.

Take care,
Lisa

[Author]

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