Dr. Sullivan on Immunotherapy Approaches in Melanoma

Ryan J. Sullivan, MD, assistant professor of medicine, Harvard Medical School, assistant professor of hematology/oncology, Massachusetts General Hospital, discusses treatment approaches with immunotherapy for patients with melanoma.

Patients with BRAF-mutant or BRAF wild-type melanoma who are eligible for immunotherapy can receive single-agent PD-1 inhibition or combination immunotherapy comprised of a PD-1 inhibitor and a CTLA-4 inhibitor. Combination immunotherapy induces high response rates and better progression-free survival relative to single-agent therapy. However, it is unknown whether combination strategies confer a benefit in overall survival, says Sullivan.

Notably, combination therapies result in more toxicity compared with single-agent therapy. Therefore, it is important to consider the patients in whom the benefits will outweigh the risks. For patients with brain metastases, the benefits of combination therapy outweigh the risks, which is why combination immunotherapy is recommended for these patients, says Sullivan. Patients with widespread disease and a poor prognosis are also typically given combination therapy to induce quick responses. In patients who don’t fall into these categories, it is appropriate to administer single-agent therapy first, followed by combination therapy upon progression, adds Sullivan.