Immunotherapy in Melanoma: Navigating Special Patient Populations
Source: Dermatology Times, December 2023
The Society for Immunotherapy of Cancer recently published insights into the management of patients with preexisting autoimmune disease, solid organ transplant recipients, elderly individuals, those living with HIV, pregnant patients, and those with rare noncutaneous subtypes of melanoma.
The landscape of melanoma treatment has undergone a radical transformation over the past decade, primarily due to the advent of immune checkpoint inhibitors (ICIs). These agents, specifically those targeting PD-1, alone or in combination with cytotoxic T-lymphocyte–associated antigen 4 or anti–lymphocyte-activation gene 3, have revolutionized the approach to chemotherapy-resistant metastatic cutaneous melanoma. However, the efficacy and safety of ICIs in special patient populations, historically excluded from clinical trials, remain a complex challenge for dermatology clinicians and oncologists. The Society for Immunotherapy of Cancer recently published insights into the management of patients with preexisting autoimmune disease, solid organ transplant recipients, elderly individuals, those living with HIV, pregnant patients, and those with rare noncutaneous subtypes of melanoma.
Patients With Altered Immune Systems
ICIs may be considered for those with preexisting autoimmune diseases, with careful risk-benefit analysis. Patients with melanoma whose immune systems are already altered should not be automatically ruled out from receiving ICI therapy. Since immunotherapy holds the potential for curing melanoma, it is advisable to refer such patients to a specialized cancer center for evaluation of treatment options. The decision to start ICI therapy should involve shared decision-making among the patient, health care provider, and collaborative care team, considering the risks and benefits specific to these individuals.