Current Status in Rechallenge of Immunotherapy

Abstract

The treatment of malignant tumors has entered the era of immunotherapy, and immune checkpoint inhibitors (ICIs) have brought significant benefits to patients. However, some patients are required to discontinue treatment with ICIs owing to factors such as disease progression and intolerable side effects. Faced with limited subsequent treatment options and complex medical needs, we searched PubMed, Embase, Cochrane library, and the NIH clinical trials database and found that ICI rechallenge could be a relevant clinical strategy. The factors that could affect the rechallenge efficacy include the patients' characteristics, therapeutic strategy selection, and the timing of treatment. Multiple factors are used to identify target population, of which clinical features and PD-L1 expression are more potential. Both single ICI rechallenge and combination therapy may have survival benefits. Patients who have tolerated initial immunotherapy well could undergo ICI rechallenge, while patients who have experienced grade 3 or higher immune-related adverse events should be carefully assessed prior to rechallenge. Interventions and the interval between two courses of ICI will clearly have an impact on the efficacy of subsequent treatment. Preliminary data evaluation supports further investigation on ICI rechallenge to identify the factors that could contribute to its efficacy.

Extensive Stage Small-Cell Lung Cancer with Cystic Brain Metastases: A Report of Two Cases

“…In recent years, data on the safety and efficacy of restarting ICI after immunotherapy have been interrupted by the presence of many irAEs. 29 A retrospective analysis concluded that it was relatively safe to continue or rechallenge patients with advanced cancers on immunotherapy-based regimens after the development of certain grade ≥2 irAEs, except for cardiac, neurological, or any grade 4 irAEs. 30 Another cohort study analyzing irAEs after ICI reactivation showed a recurrence rate of 28.8% (95% CI, 24.8-33.1).…”

Harnessing the power of traditional Chinese medicine monomers and compound prescriptions to boost cancer immunotherapy

“…This heterogeneity may arise from variances in patients’ immune system profiles or the distinct characteristics of their specific cancers. Another limitation of immunotherapy pertains to the potential occurrence of side effects ( 144 ). Although immunotherapy generally exhibits lower toxicity compared to traditional cancer treatments, it can still induce immune-related side effects such as inflammation, fatigue, and cutaneous manifestations ( 144 , 145 ).…”

“…Another limitation of immunotherapy pertains to the potential occurrence of side effects ( 144 ). Although immunotherapy generally exhibits lower toxicity compared to traditional cancer treatments, it can still induce immune-related side effects such as inflammation, fatigue, and cutaneous manifestations ( 144 , 145 ). In certain instances, these side effects may severely manifest and urgently demand intervention.…”

Opportunistic Infections and Immune-Related Adverse Events Associated with Administering Immune Checkpoint Inhibitors: A Narrative Review

“…The more common strategy is using a high-affinity monoclonal antibody to block the inhibitory receptors. In this way, ICI blockade induces a complete reactivation of the host immune system that permits the attack of tumour cells [ 35 ]. Table 1 summarises the current IMT used.…”