title: Efficacy and toxicity of rechallenge with combination immune checkpoint blockade in metastatic melanoma: a case series.
abstract: The efficacy and potential toxicity of rechallenge with combination ipilimumab and nivolumab has not been described. Retreatment of patients with immune checkpoint inhibitors in the setting of prior significant toxicity lacks evidence-based guidance.
  
  
  
  We present the first three, consecutive patients who received re-treatment with combination ipilimumab and nivolumab for metastatic melanoma managed at our institution.
  
  
  
  Rechallenge with combination ipilimumab and nivolumab in the setting of prior grade 3 toxicity with initial combination therapy is feasible, and responses are seen. We highlight the fact that grade 3 toxicity is likely to recur, but if so, can be manageable.
  
  
  
  Retreatment with ipi + nivo may be considered an option in carefully selected, well-informed patients. More research is required to delineate the benefits and risks with this approach.
authors.affiliation: Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Spain
authors.affiliation: Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Gerard
authors.initials: G
authors.lastname: Walls
authors.affiliation: Radiology Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Messiou
authors.affiliation: Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK.|The Francis Crick Institute, London, UK.
authors.forename: Samra
authors.initials: S
authors.lastname: Turajlic
authors.affiliation: Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Gore
authors.affiliation: Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK. james.larkin@rmh.nhs.uk.|Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK. james.larkin@rmh.nhs.uk.
authors.forename: James
authors.initials: J
authors.lastname: Larkin
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis; D000077594:Nivolumab
chemical_list: D000911:Antibodies, Monoclonal; D000074324:Ipilimumab; D000077594:Nivolumab
keywords: Advanced melanoma; Combination immune checkpoint therapy; Immune-related toxicity; Ipilimumab; Nivolumab