GRACE :: Cancer Basics



Dr West

How long should we continue immune checkpoint inhibitor therapy in patients who respond?


Over the past several years we have seen some great triumphs  in a subset of patients with advanced cancers who received an immune checkpoint inhibitor like Opdivo (nivolumab), Keytruda (pembrolizumab), or a growing list of other agents that act by removing a braking mechanism on the immune system and can stimulate it to recognize and attack the cancer.. In some patients, we can see the cancer shrink to the point of actually having no evidence of disease (NED) on post-treatment scans.  In many other patients. the cancer will shrink (sometimes immediately, sometimes after a delay of a few months), then remain visible but smaller for a long time.  In the original trials, most treatment protocols plan to have patients continue on ongoing IV therapy with these therapies meant to be given every 2 or 3 weeks, without any endpoint until their cancer shows significant progression or the patient develops significant side effects.  There are reasons to be tempted to discontinue treatment at some point: many of the leading experts with the most experience in immunotherapy have seen side effects that seem to be cumulative, raising the question of whether continued treatment with an immune checkpoint inhibitor for more than 6 or 12 months adds anything other than risk, inconvenience of coming in for infusions every few weeks, and major expense.  Many patients are also inclined to not be tethered to the clinic for regular visits and infusions every few weeks if they add no real value. And one of the basic tenets of immune response is that the immune system has a memory and may continue to respond to a recognized target or a very long time, even without ongoing active stimulation.

Moreover, many of these trials often allow patients to continue on immunotherapy after scans show evidence of tumor growth, based on the concept of pseudo-progression that I described in detail previously. I noted the potential harm of having patients continue on immunotherapy while their cancer was actually progressing, but how long should we continue a patient on immunotherapy when they’re doing well? Is there any end, or should we have them continue on immunotherapy indefinitely?  

Continue reading

Ask Us, Q&A
Cancer Basics Expert Content



GRACE Cancer Video Library - Lung Cancer Videos




2015 Acquired Resistance in Lung Cancer Patient Forum Videos


Join the GRACE Faculty

Lung/Thoracic Cancer Blog
Breast Cancer Blog
Pancreatic Cancer Blog
Bladder Cancer Blog
Head/Neck Cancer Blog
Kidney Cancer Blog

Subscribe to the GRACEcast Podcast on iTunes


Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon

Subscribe to
   (Free Newsletter)

Other Resources


Biomedical Learning Institute