Managing Expectations: Adverse Events With Melanoma Immunotherapy

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

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EP: 5.Managing Expectations: Adverse Events With Melanoma Immunotherapy

EP: 6.Immunotherapy Dosing Strategies: Optimizing Efficacy and Managing Toxicity in Melanoma

Toxicity Profiles of Immunotherapy Regimens

Key Discussion Points:

• Immunotherapy regimens share similar categories of adverse events but differ significantly in frequency and severity
• Patient education and preparation for toxicity management are critical components of immunotherapy administration
• Specific toxicities are more commonly associated with certain regimens

Key Points for Physicians:

• Common immune-related adverse events across regimens include cutaneous reactions, colitis, hepatitis, and endocrinopathies, with severity rates varying by regimen
• Grade 3/4 toxicity rates differ substantially: 10%-15% with PD-1 monotherapy, approximately 19%-20% with relatlimab/nivolumab, >60% with ipilimumab/nivolumab (3mg/kg ipi)
• CheckMate 511 demonstrated reduced toxicity with “flip dosing” (ipi 1mg/kg, nivo 3mg/kg) compared to standard dosing (30%-35% vs >60% grade 3/4 toxicities)

Notable Insights:

While toxicity profiles are broadly similar between regimens, certain toxicities are more associated with specific agents—colitis is particularly associated with ipilimumab, and preliminary data suggests potentially higher incidence of myocarditis with relatlimab-containing regimens.

Clinical Significance:

Understanding the distinct toxicity profiles and management strategies for immunotherapy regimens enables clinicians to select appropriate treatment approaches while preparing both the health care team and patients for potential adverse events.