In elderly patients with advanced melanoma and idiopathic pulmonary fibrosis receiving active antifibrotic therapy, would neoadjuvant or adjuvant immune checkpoint inhibition be preferred?

Given this scenario, it is most important to have a goal-of-care discussion. That would help sort out the optimal treatment for such patients. Always treat to relieve pain as needed.

I'd be very careful with the use of immunotherapy in an elderly patient with any sort of autoimmune disease, especially when receiving disease-modifying therapy. Having said that, there is no such contraindication to giving immunotherapy in such patients.

• Neoadjuvant setting: It is always preferred ...

Additional information is needed to weigh risks and benefits, as well as life expectancy, before making a decision.

I would really avoid ICI at all in these pts, as the potential risk of irAE such as pneumonitis on top of pre-existing ILD leading to significant clinical events is too high. I tend to prefer BRAF/MEK targeted therapy if BRAF V600E/K mutations are present), or consider TIL therapy as it works differ...