scholarly journals Complete Response to Anti-PD-1 Antibody Monotherapy in Metastatic Melanoma-Can Therapy be Discontinued? A Review of Current Literature

2019 ◽  
pp. 214-219
Author(s):  
Aby Z Philip
Keyword(s):  
Metastatic Melanoma ◽  
Prospective Studies ◽  
Complete Response ◽  
Current Data ◽  
Duration Of Therapy ◽  
Treatment Review ◽  
Discontinuation Of Treatment ◽  
Optimal Duration ◽  
The Ideal

Newer immunotherapeutic agents such as Nivolumab and Pembrolizumab have changed the landscape of management of metastatic melanoma, with a subset of patients achieving durable responses. The ideal duration of therapy in patients who achieve a complete response with these agents has not been determined. We report a case of a 68 year old man with metastatic melanoma who progressed with Ipilimumab and BRAF-directed therapies, but achieved a complete response with Nivolumab monotherapy and continues to be in remission at almost 2 years after discontinuation of treatment. Review of the current data indicates that discontinuation of anti-PD-1 antibodies after complete response is achieved is feasible. The majority of these patients maintain their responses long-term. In those who relapse, re-treatment with the same agent is effective in most cases according to the current data. Prospective studies are necessary to determine the optimal duration of therapy and strategies to maximize the benefit of these drugs.

scholarly journals Real-World Survival in Patients with Metastatic Melanoma after Discontinuation of Anti-PD-1 Immunotherapy for Objective Response or Adverse Effects: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Julie Valentin ◽  
Thomas Ferté ◽  
Valérie Dorizy-Vuong ◽  
Léa Dousset ◽  
Sorilla Prey ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Metastatic Melanoma ◽  
Single Agent ◽  
Objective Response ◽  
Progression Free Survival ◽  
Complete Response ◽  
Advanced Melanoma ◽  
Discontinuation Of Treatment

Objective. Anti-PD-1 has dramatically improved the survival of patients with advanced melanoma. However, there is a lack of data on maintenance of the response after treatment discontinuation. We aimed to evaluate the progression-free survival (PFS) of patients with metastatic melanoma after anti-PD-1 interruption for objective response (OR) or limiting toxicity during clinical trials. Methods. All patients with advanced melanoma who stopped single-agent anti-PD-1 antibodies for objective response or toxicity were included between April 2014 and January 2019 in our institution (data cut-off, September 10th, 2019). Clinical and biological factors associated with relapse were studied. Results. The median follow-up after introduction of treatment was 36.5 months [4.6–62.4], and the median follow-up after discontinuation of treatment was 15.7 months (2.5–45.1). Out of 65 patients, 28 patients stopped immunotherapy for limiting adverse effects (AEs) (43.1%), 25 for complete response (CR) (38.4%), and 12 for partial response (PR) or long-term stable disease (SD) (18.5%). Twelve patients relapsed (18.5%) after a median time of 9 months [1.9–40.9 months]. Seven relapsed after discontinuation for AEs, 3 after discontinuation for CR, and 2 after discontinuation for PR/SD. The median PFS after therapy discontinuation was not reached. No statistical association was found between recurrence and age, sex, increased LDH, BRAF status, presence of brain metastases, previous treatments, radiotherapy, or time on anti-PD-1 treatment. Conclusion. This cohort shows a global recurrence rate of 18.5% and confirms a long-lasting response after anti-PD-1 cessation regardless of the cause of discontinuation.

scholarly journals Induced Vitiligo due to Talimogene Laherparepvec Injection for Metastatic Melanoma Associated with Long-term Complete Response

2019 ◽  
Vol 99 (2) ◽  
pp. 232-233 ◽  
Author(s):  
P Iglesias ◽  
S Ribero ◽  
A Barreiro ◽  
S Podlipnik ◽  
C Carrera ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Complete Response ◽  
Talimogene Laherparepvec

scholarly journals Durability of response in metastatic melanoma patients after combined treatment with radiation therapy and ipilimumab

2020 ◽  
Vol 7 (1) ◽  
pp. 7-15
Author(s):  
Quaovi H Sodji ◽  
Paulina M Gutkin ◽  
Susan M Swetter ◽  
Sunil A Reddy ◽  
Susan M Hiniker ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Metastatic Melanoma ◽  
Combined Treatment ◽  
Prospective Trial ◽  
Complete Response ◽  
The Third ◽  
Long Term Follow Up ◽  
Melanoma Patients

Aim: We previously reported a prospective trial evaluating the safety and efficacy of combining ipilimumab and radiation therapy in patients with metastatic melanoma. Herein, we provide a long-term update on patients with complete response (CR) or partial response (PR). Patients & methods: We continued to follow these patients with serial imaging including computed tomography, PET or MRI. Results: Two of the three patients with CR are still alive and without evidence of melanoma but with chronic treatment-induced hypophysitis. The third patient died of hepatocellular carcinoma, but with no evidence of melanoma. Among the three patients with PR, two achieved CR after pembrolizumab monotherapy. Conclusion: This long-term follow up reveals the striking durability of the CRs, which appears to correlate with a grade 2–3 hypophysitis.

Long-term clinical results of the combination of cisplatin (C), vinblastine (V), DTIC (D) and interferon-alfa (I) with or without tamoxifen (T) for metastatic melanoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8039-8039
Author(s):  
A. M. Sanguino ◽  
A. Y. Bedikian ◽  
S. S. Legha ◽  
M. A. Detry ◽  
N. E. Papadopoulos ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Interim Analysis ◽  
Response Rate ◽  
Complete Response ◽  
Clinical Results ◽  
Term Survival ◽  
Long Term Survival ◽  
Group A ◽  
Group B

8039 Background: According to 2001 AJCC data, 1-yr, 2-yr, 5-yr, and 10-yr survival of melanoma patients (pts) with stage M1c were 40.6%, 23.6%, 9.5% and 6.0%, respectively. Previously, we reported the interim results of a randomized phase II trial comparing the response rates (RR) of CVDI vs. CVDI +T. Here we report long-term survival results of these pts. Methods: Chemo-naïve pts between 16 and 75 yrs of age, with histologically documented diagnosis of advanced melanoma and without symptomatic brain metastasis, were randomized to receive either CVDI (group A) or CVDI+T (group B). The dose of each drug is as follows: C 15 mg/m2 IV (d 2–5), V 1.2 mg/m2 IV (d 1–5), D 600 mg/m2 IV (d 1), I 5 MU/m2 SQ 3 times a wk and T 20 mg twice a day. The treatment was administered every 3–4 wks. After the interim analysis, the arm with a higher RR was selected for an expansion cohort (group C). The primary endpoint was the RR of CVDI regimen with or without T. The secondary endpoint was overall survival (OS) evaluation. Results: A total of 104 pts were enrolled, among which 36 and 34 were randomized to group A and B, respectively. After interim analysis of 70 pts, the CVDI regimen was selected for group C. There were no significant differences in both RR (p= 0.126) and OS (p= 0.095) between group A and B. When all 104 pt data were combined, the overall response rate (ORR) was 37.5% with a complete response rate (CRR) of 8.7% and the median survival of 10.4 months. One-yr, 2-yr, 5-yr, and 10-yr OS were 43%, 20%, 7% and 4%, respectively. Conclusions: Although the combination of CVDI with or without T is an active regimen for treatment for metastatic melanoma, long-term survival of pts receiving this regimen is similar to historical controls. [Table: see text] No significant financial relationships to disclose.

Long-term survival of patients with metastatic melanoma (MM) treated with dacarbazine (DTIC) or temozolomide (TMZ)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9054-9054
Author(s):  
C. Kim ◽  
C. W. Lee ◽  
R. Klasa ◽  
A. Shah ◽  
K. J. Savage
Keyword(s):  
Metastatic Melanoma ◽  
Tumor Biology ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Complete Response ◽  
Similar Efficacy ◽  
Limited Information ◽  
Term Survival ◽  
Long Term Survival

9054 Background: Patients with metastatic melanoma (MM) generally have a poor prognosis, with a median survival of 6 to 9 months. There is a small proportion of patients who achieve long term survival (LTS), however, it is unclear whether LTS reflects sensitivity to systemic therapy, indolent tumor biology or host immune factors. Dacarbazine (DTIC) is the only approved chemotherapy for the treatment of MM, although temozolomide (TMZ) has similar efficacy. There is limited information as to the frequency of complete response (CR) following DTIC or TMZ, duration of response and whether LTS occurs only in patients who achieve a CR. We sought to identify all patients with MM treated with either DTIC (alone or in combinations) or TMZ at the BC Cancer Agency (BCCA) who achieved LTS defined as survival ≥ 18 months from the time of administration of chemotherapy. Methods: All patients with MM treated with either DTIC or TMZ from January 1, 1988 to February 1, 2006 were identified in the BCCA pharmacy database. The BCCA surveillance and outcomes unit (SAO) was utilized to identify cases of LTS. CR was defined as disappearance of all disease by diagnostic imaging. Given the retrospective nature of the analysis, progressive disease (PD) was defined as any tumor growth, and partial response or stable disease (PR/SD) were combined. Results: In the 18-year period reviewed, 397 patients with MM were treated with DTIC (n= 349) or TMZ (n=48). Of these, 45 patients met the criterion of LTS and had the following characteristics: median age 53 (range 22–86); male 67 %; ocular primary 7%; non-pulmonary visceral metastases 38%; DTIC 11.7% (41/349), TMZ 8.3% (4/48). The best response to DTIC or TMZ documented was: CR 18%, PR/SD 67%, PD 13%. The 5-year overall and progression-free survival rates were 33% and 12%, respectively. Eleven patients survived > 5 years (range 5–27.5), and 6 patients remain in remission (5 CR, 1 PR). Disease progression occurred in 5 patients in < 1 year however, they remain alive for at least 5 years (range 5.2–17.9). Conclusions: LTS occurs in patients with MM treated with either DTIC or TMZ. However, a minority have a sustained response following chemotherapy, and most cases of LTS are likely the result of indolent disease or host biology. No significant financial relationships to disclose.

Idiopathic venous thrombosis

2006 ◽  
Vol 26 (01) ◽  
pp. 52-54 ◽  
Author(s):  
P. A. Kyrle
Keyword(s):  
Chronic Disease ◽  
Venous Thrombosis ◽  
Vitamin K ◽  
Clinical Benefit ◽  
Plasma Levels ◽  
Vitamin K Antagonists ◽  
Antithrombin Deficiency ◽  
Optimal Duration ◽  
Risk Of Treatment

SummaryVenous thrombosis is a chronic disease with a recurrence rate of approximately 30% within 5-8 years. The optimal duration of secondary thromboprophylaxis in these patients entails balancing the risk of recurrence against the risk of treatment-associated bleeding. There is agreement that patients with a first idiopathic venous thrombosis should receive vitamin K antagonists for at least 3-6 months. Convincing trials showing a clinical benefit in terms of morbidity or mortality with respect to expansion of anticoagulation beyond 6 months are lacking. Nevertheless, some subgroups of patients with venous thrombosis may benefit from indefinite anticoagulation. Thus, patients with antithrombin deficiency, combined or homozygous defects, more than one unprovoked episode of thrombosis, the lupus anticoagulant or high factor VIII plasma levels are good candidates for long-term prevention.

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