Immune checkpoint inhibitor combinations: challenges and future perspectives

Marc S. Ernstoff, MD from Roswell Park Cancer Institute, Buffalo, NY, talks about the challenges associated with immunotherapy combination treatments. Focusing on anti-PD-1 checkpoint inhibitors such as nivolumab and ipilimumab, he explains that when these are combined, treatment toxicities seem to increase significantly. The challenge is to identify which patients would benefit from combination treatments versus single anti-PD-1 therapy. Recent analyses have suggested that PD-L1 expression may identify patients that would benefit from single PD-1 inhibitor therapy, whereas low PD-L1 expression may identify those who would benefit from doublet anti-PD-1 therapy. However, reliable biomarkers for identifying these patients remain elusive.
As more immunotherapies emerge, it is important to establish rational ways in which they can be combined effectively. One approach would be to examine specific biomarkers within the tumor microenvironment and identify which combinations may be of benefit to the patients.

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