{
  "abstract": "Background Immune checkpoint inhibitors (ICIs) have transformed outcomes for patients with advanced melanoma. However, they are frequently associated with immune-related adverse events (irAE), which present a new challenge in optimal patient management.Methods We conducted a retrospective analysis of patients with malignant melanoma who received immunotherapy at our institution. Real world treatment patterns, irAE, and outcomes were analyzed in detail.Results From January 2003 to September 2022, 453 patients were diagnosed with malignant melanoma and were treated with immunotherapy or targeted therapy. The median age of all patients was 61 years. 66.0% were male (n = 299), and 94.9% were white (n = 430). The majority (86.1%, n = 390) had cutaneous melanoma. BRAF V600 mutation was positive in 29.1% (n = 132) of patients, and testing for this mutation was not performed in 21 patients. 82.7% (n = 375) had a primary resection of melanoma and 33.1% (n = 150) received adjuvant chemo/immunotherapy. All patients received immunotherapy along their treatment course. 43.7% received a single-agent anti-PD1, 9.1% received a CTLA4 inhibitor, and 4.0% received a targeted therapy. 34.9% had complete response, 24.1% had partial response, 9.5% had stable disease, and 31.6% had progressive disease on immunotherapy. Most patients (61.6%, n = 279) experienced one or more irAE. 54.8% of these patients (n = 153) had mild to moderate irAE (grade 1-2). 34.1% had grade 3 irAE, 6.5% had grade 4 irAE, and 1.8% had grade 5 irAE. Of those who experienced an irAE, 66.7% (n = 186) required treatment cessation or pause, and of these, 57.5% (n = 107) were rechallenged with an ICI. Median OS for the entire cohort from date of IO initiation was 51.6 months, and median OS for those who experienced irAE was 70.9 months.Conclusions More than half of patients who receive ICI and experienced irAE were rechallenged, with most experiencing a subsequent irAE. Re-challenge of ICI following irAEs is possible in a proportion of patients with malignant melanoma and may be associated with improved overall survival. This treatment strategy warrants careful clinical evaluation on an individual basis.Ethics Approval The study was approved by the University of Virginia Institutional Review Board.",
  "authors": [
    {
      "affiliations": [
        "Cleveland Clinic, Cleveland, OH, USA"
      ],
      "name": "Amrita Ladwa"
    },
    {
      "affiliations": [
        "University of Virginia, Charlottesville, VA, USA"
      ],
      "name": "Mu-Hsun Chen"
    },
    {
      "affiliations": [
        "University of Virginia School of Medicine, Charlottesville, VA, USA"
      ],
      "name": "Susanna D’Silva"
    },
    {
      "affiliations": [
        "University of Pennsylvania, Philadelphia, PA, USA"
      ],
      "name": "Omar Elghawy"
    },
    {
      "affiliations": [
        "University of Virginia, Charlottesville, VA, USA"
      ],
      "name": "Jacob S Friedberg"
    },
    {
      "affiliations": [
        "University of Virginia, Charlottesville, VA, USA"
      ],
      "name": "Hong Zhu"
    },
    {
      "affiliations": [
        "University of Virginia, Charlottesville, VA, USA"
      ],
      "name": "Varinder Kaur"
    }
  ],
  "title": "1059 Immune checkpoint inhibitors, irAE, and treatment patterns in patients with melanoma: a single center experience",
  "uid": "9529ba8f-1827-57c4-8a59-24694a789ffc"
}