Clinical Perspectives: Single-Agent Vs Combination Immunotherapy for Melanoma
Panelists discuss how monotherapy may still be appropriate for certain patient populations including those with desmoplastic melanoma, solid organ transplants, severe autoimmune disease, and older patients where the toxicity risk of combination therapy may outweigh benefits.
EP: 1.The Evolving Treatment Paradigm in Melanoma: Targeted Therapy vs Immunotherapy
EP: 2.Frontline Treatment Options for Melanoma
EP: 3.Clinical Perspectives: Single-Agent Vs Combination Immunotherapy for Melanoma
EP: 4.Combination Immunotherapy Strategies in Melanoma: Insights From Key Trials
Monotherapy Indications and Special Populations
Key Discussion Points:
- Certain patient populations may benefit from PD-1 monotherapy despite the general trend toward combination therapy
- Autoimmune comorbidities significantly impact immunotherapy selection decisions
- Disease burden and anatomic distribution influence therapy intensity decisions
Key Points for Physicians:
- Desmoplastic melanoma, solid organ transplant recipients, and patients with severe autoimmune disease should be considered for PD-1 monotherapy
- Patients with limited disease burden (cutaneous-only or lung-only disease) often respond well to monotherapy
- Certain autoimmune conditions carry particularly high risk with combination therapy, including active inflammatory bowel disease and myasthenia gravis
Notable Insights:
Autoimmune disease risk varies by condition—inflammatory bowel disease and myasthenia gravis carry higher flare rates with ipilimumab, though a recent study showed no flares in 10 patients with prior Guillain-Barré syndrome.
Clinical Significance:
Despite the trend toward combination immunotherapy, patient-specific factors including autoimmune comorbidities, age, and disease burden remain critical factors in selecting between monotherapy and combination approaches.
