How do you counsel patients with metastatic NSCLC who have a sustained response (> 2 years) to checkpoint inhibitors who wish to discontinue therapy?
How do you approach this given the limited # of patients this applies to? Checkmate 017 and 057 only had 5-7% of patients still on nivolumab at 3 years and in Keynote 010 with similar % of patients completing 2 years of therapy.
Answer from: Medical Oncologist at Community Practice
I generally recommend stopping treatment after 2 years of checkpoint inhibition. I fully agree that there is a paucity of data as it relates to the duration of checkpoint inhibitor therapy in cancer. However some general trends across cancer types are emerging. For example, the quality of respo...
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Answer from: Medical Oncologist at Community Practice
Based on available and emerging data, it seems that continuing beyond 2 years may be beneficial. However, potential toxicity and impact on patient's QoL need to be weighed against benefit. There is data to support retreatment with immunotherapy in patients who progress while off of all treatment aft...
Comments
Medical Oncologist at NYU Winthrop Hospital
If immunotherapy is paid by insurance and there ar...
If immunotherapy is paid by insurance and there ar...
Medical Oncologist at Kaiser Permanente
I would appreciate sharing of the citations for da...
I would appreciate sharing of the citations for da...
Medical Oncologist at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
This is one reference.Also look at this uptodate s...
This is one reference.Also look at this uptodate s...
Answer from: Medical Oncologist at Community Practice
Personally, I would take the opportunity to see if we can learn from whatever this patient or you chose to do by learning the value of a measurement of Minimal Residual disease for decision making. The most sensitive assay which can detect 3 cells in 100,000 in solid tumors has just been published i...
Answer from: Medical Oncologist at Academic Institution
I would stop treatment only for those patients are in CR even before two years of treatment. If active disease at two years, I would recommend to continue IO.