Immunotherapy Rechallenge

Principles of Immunotherapy Rechallenge After irAE

– Principles of Immunotherapy Rechallenge After irAE – Exercise caution when considering resumption of immunotherapy after significant irAEs. Close follow-up should be performed when resuming immunotherapy to monitor for recurrent symptoms

– Assess patient’s tumor status prior to rechallenge. If an objective response (complete or partial) to ICI therapy was achieved, resumption of immunotherapy may not be advisable because of risk of toxicity recurrence. Discuss the risks/benefits of restarting immunotherapy with the patient

– If rechallenged and toxicity returns, permanently discontinue class of immunotherapy.

– Permanent discontinuation of a given class of immunotherapy is typically warranted in the setting of severe irAEs induced by that class of immunotherapy and may be warranted in the setting of moderate irAEs. For example, if a patient experiences Grade 3 or 4 toxicity from an ipilimumab-containing regimen, consideration may be given to later therapy with a PD-1 or PD-L1 monotherapy after resolution of the earlier toxicity

– With some exceptions, resumption of immunotherapy following Grade 2 irAEs can be considered upon resolution to Grade ≤1

– Consult with organ-specific specialist prior to resumption of immunotherapy as appropriate following an immunotherapy hold due to irAEs