ESMO 2018: Immune Therapies Going Adjuvant: Benefits Versus Risks: How Long Should We Treat Patients?

Munich, Germany (UroToday.com) In this session, Dr. John Haanen discusses the rationale for adjuvant therapy. First, the basis for adjuvant therapy with IO’s (immune-oncology, or immune checkpoint inhibitors) has long been there with other therapeutic agents – chemotherapy, Her2 targeting agents, antihormonal therapies). However, all these agents targeted the tumor directly – IO’s target the immune system directly and the tumor indirectly, so it is unclear if the concept of adjuvant therapy holds true.

Benefits of adjuvant IO therapy include:
1) Prevention of getting stage 4 metastatic disease
2) Possibly shorter duration of treatment (1 year vs. 2 years in metastatic setting)
3) Possible “better” immune system as patients are usually healthier and more robust
4) Normal LDG or good performance status

However, on the contrary, because they are healthier, to begin with – they may have more side effects and a portion may get unnecessary treatment.

He focused a bit on the melanoma situation with Stage 3 tumors – multiple recent studies have suggested RFS benefit in stage III disease. But the benefit varies from stage 3a to stage 3d disease – and weighing the risks/benefits at each stage is important, and is very patient-specific.

His open questions for adjuvant IO therapy are:
UroToday ESMO2018 Whattotellyourpatients

These are yet unanswered in all disease states, and further work is needed.


Presented by: John B. Haanen, MD, Head of the Division of Medical Oncology and Staff Scientist in the Division of Immunology, Professor of Translational Immunotherapy of Cancer at Leiden University Medical Centre, Amsterdam, the Netherlands

Written by: Thenappan Chandrasekar, MD, Clinical Instructor, Thomas Jefferson University, twitter: @tchandra_uromd, @TjuUrology at the 2018 European Society for Medical Oncology Congress (#ESMO18), October 19-23,  2018, Munich Germany