Dr. Ribas on Immune-Related Adverse Events in Melanoma

Antoni Ribas, MD, PhD, professor of medicine, University of California, Los Angeles, director, Tumor Immunology Program, Jonsson Comprehensive Cancer Center, discusses immune-related adverse events (irAEs) in melanoma.

With immune checkpoint inhibition, physicians have to be aware of the potential irAEs, which may include autoimmune reactions or inflammatory toxicities, says Ribas. Over time, physicians have become more comfortable with using these agents. As such, physicians have been able to better recognize and manage irAEs with earlier intervention strategies, some of which may include immunosuppressive agents, such as corticosteroids.

In terms of the therapies themselves, single-agent PD-1/PD-L1 therapy shows a lower frequency of irAEs compared with when it is used in combination with CTLA-4 inhibitors. In general, combination immunotherapy shows a higher rate of toxicity, says Ribas. Most recently, the FDA approved the PD-1 inhibitor pembrolizumab (Keytruda) as adjuvant therapy for patients with high-risk stage III melanoma with lymph node involvement following complete resection. Nivolumab (Opdivo) and ipilimumab (Yervoy) also hold indications in this setting.