Clinical Perspectives: Single-Agent Vs Combination Immunotherapy for Melanoma

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.