Current oncology reports
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Prognosis of patients with advanced melanoma is dismal with a median overall survival of about 8 months and 5-year overall survival from a diagnosis of metastatic disease of roughly 10%. However, immune checkpoint inhibitors have brought indispensable benefits to melanoma patients. Here we will review the recent clinical efficacy and adverse events of immune checkpoint inhibitors for melanoma patients. ⋯ The immune checkpoint inhibitors increase confirmed objective response and prolong progression-free and overall survival of the afflicted patients in association with maintaining their quality of life. Although diverse immune-related adverse events occur, most of them are manageable by appropriate immunomodulating agents. Clinical efficacy of immune checkpoint inhibitors continues even after discontinuation of drugs. Compared with conventional therapeutic options, the immune checkpoint inhibitors appear to prolong the survival of patients with advanced melanoma. Further clinical trials are warranted to determine whether their combinatory use with other treatment options may augment benefits or not.
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Current oncology reports · Mar 2018
ReviewIncidence and Management of Immune-Related Adverse Events in Patients Undergoing Treatment with Immune Checkpoint Inhibitors.
The unleashing of the immune system in an effort to fight cancer has proven to be an incredible advance in the war on cancer. However that breakthrough has come with a price in the form of serious and potentially fatal immune-related adverse events (irAEs). ⋯ Rapid recognition and early intervention is imperative to avoid significant morbidity and mortality. Additionally, providers need to be aware that there are still new, rare, and long-term emerging irAEs that were not previously reported in clinical trials. Because of the significant difference between irAEs and those caused by chemotherapy and/or targeted therapy, providers must have a thorough understanding of which events would be considered immune related and require treatment. This review will cover descriptions of the most common and uncommon but serious irAEs experienced by patients on immunotherapy, as well as management of these irAEs.
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The incidence of cutaneous melanoma in the elderly continues to rise. Immunotherapies such as the immune checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab have shown great promise in the management of this disease. ⋯ Though at first glance immunotherapy for melanoma may appear to be a one-size fits all when it comes to age, a rationale is evolving for why this approach may warrant additional personalization in the older patient. This paper aims to summarize the clinical experience with these agents for elderly melanoma patients, as well as to introduce the concept of a personalized approach for elderly patients with consideration of incidence and management of side effects, and strategies for optimizing efficacy in the context of an aging immune system.