Durable response after discontinuation of nivolumab therapy in the absence of disease progression or toxicity with two advanced NSCLC patients

Abstract

Background Nivolumab is an immune checkpoint inhibitor that selectively blocks the programmed cell death-1 (PD-1). Nowadays, immune checkpoint inhibitors such as nivolumab are used in the treatment of many different types of cancer. In prospective clinical trials, the duration of therapy with nivolumab has been defined as up to the time of progressive disease or treatment limiting toxicity. Case reports In this article, we present two advanced non-small cell lung cancer (NSCLC) patients that were treated with anti-PD-1 monotherapy in the second-line setting. They have received nivolumab for nine and five months, respectively. After discontinuation of immunotherapy agent because of socioeconomic reasons, they had a durable response. Management and outcome After the discontinuation of nivolumab in the absence of progression or toxicity, the clinic and radiologic response are still ongoing. Discussion Optimal duration of anti-PD-1 therapy has not been established. There are some reports that indicate the durable response for the patients who have interrupted immunotherapy because of toxicity. Here, we present two advanced NSCLC patients having a durable response after discontinuing the treatment in the absence of toxicity and disease progression. More extensive research is needed to determine which subgroups of patients treated with immunotherapy can cease treatment and maintain an ongoing response.

Complete response of squamous cell carcinoma of the lung following treatment with pembrolizumab in an elderly patient: A case report

“…Although it is reportedly better to maintain ICIs, all patients who achieved CR were long‐term survivors and had no signs of disease relapse 15 . However, there is no clear evidence on how long treatment should continue 16,17 . Other studies have reported that the drug was effective once it was discontinued and readministered when it recurred 18,19 .…”

“…15 However, there is no clear evidence on how long treatment should continue. 16,17 Other studies have reported that the drug was effective once it was discontinued and readministered when it recurred. 18,19 If the tumor completely disappears as in the present case, then it may be possible to administer pembrolizumab for a certain period, discontinue it, and if cancer recurs, re-challenge it.…”

Nivolumab plus Carboplatin and Paclitaxel as the First-line Therapy for Advanced Squamous Cell Carcinoma of the Lung with Strong Programmed Death-ligand 1 Expression: A Case Report

“…The question of whether durable remission could be maintained after stopping ICI similar to our case necessitates further studies; however, two recent case series have yielded positive results. One of them even concluded that durable response could be achieved after discontinuation of ICI in the absence of toxicity [17-18]. This point of view shall be appreciated by patients who develop intolerable adverse effects or lack enough financial support for ceaseless ICI treatment.…”

The Right Dose: From Phase I to Clinical Practice

“…Although a similar analysis has not been performed (to our knowledge) for patent-protected parenteral drugs, there are some important opportunities, best exemplified by the immune checkpoint inhibitors. [49][50][51][52][53][54] Furthermore, because many patients treated with immune checkpoint inhibitors have prolonged progression-free survival (PFS) despite treatment discontinuation (e.g., due to adverse events), [55][56][57][58][59][60] the optimal duration of treatment is unknown. [61][62][63] Strategy to Identify Candidate Drugs for Financially Guided Dosing…”