Dr. Igor Puzanov, Chief of Melanoma and Director of the Early Phase Clinical Trials Program at Roswell Park Comprehensive Cancer Center in Buffalo, New York, commented by email, “This is an important study, and includes useful safety information for practicing oncologists. The findings let us know that toxicity itself is not a deal-breaker in terms of continuing a patient on a checkpoint inhibitor after an immune-related adverse event.”
“I agree fully with the strategy of intensive monitoring of this group of patients,” he told Reuters Health. “At Roswell Park, we have instituted formal monitoring for cardiac toxicity, doing weekly troponin checks for six to 12 weeks in all patients starting on a checkpoint inhibitor.”
“I would add that if a patient experiences toxicity from anti-PD-1 therapy, you manage the toxicity first, and if you need to you can consider restarting the anti-PD-1 later,” he said. “If the patient had a high-grade toxicity, you would still manage the toxicity first but should wait to see if you even need to restart the anti-PD-1 treatment, because we’ve seen that a lot of patients do well with just observation but without further treatment on a checkpoint inhibitor. If the tumor is stable, you can just watch and wait, and if they have some progression in the future then you can consider restarting the checkpoint inhibitor later.”
