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When is it OK to Stop Anti-Programmed Death 1 Receptor (PD-1) Therapy in Metastatic Melanoma?
Lauren B Banks1, Ryan J Sullivan2
1Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract:
Systemic therapy for metastatic melanoma has been revolutionized over the past decade with the development of highly effective immune checkpoint inhibition, specifically anti-Programmed Death 1 receptor (PD-1) therapy. However, even though one-third of patients will have durable response to single-agent or combination therapy, the optimal duration of therapy is unknown. Identifying the optimal duration of therapy is important, as exposure to anti-PD-1 therapy increases the risk of developing immune-mediated toxicities that can have significant morbidity and are, at times, fatal. It has long been understood that patients with complete responses to high-dose interleukin-2 and ipilimumab typically maintain their responses after a brief treatment course; thus, it is important to better understand the data to help understand the optimal management of melanoma patients treated with anti-PD-1 therapy. The clinical data with anti-PD-1-based therapy and published data on the duration of therapy suggest that patients may not require a full 2 years of anti-PD-1 therapy and that the risk of toxicity may be mitigated by further understanding the mechanisms and kinetics of response to therapy. Although novel markers to help guide therapeutic decision making are under investigation, there is an ongoing need to improve our tools to monitor response to therapy and disease activity.
Insights
Optimal duration for anti-Programmed Death-1 (PD-1) receptor therapy in metastatic melanoma is unclear. Research suggests patients may not need two years of treatment, potentially reducing toxicity risks.
Area of Science:
- Oncology
- Immunotherapy
- Dermatology
Background:
- Metastatic melanoma treatment has advanced with immune checkpoint inhibitors, particularly anti-Programmed Death-1 (PD-1) receptor therapy.
- While effective for many, the optimal duration of anti-PD-1 therapy remains undetermined.
- Prolonged anti-PD-1 exposure elevates risks of severe immune-mediated toxicities.
Purpose of the Study:
- To evaluate the optimal duration of anti-PD-1 therapy for metastatic melanoma.
- To assess if current treatment durations align with response kinetics and toxicity profiles.
- To inform clinical decision-making regarding melanoma treatment management.
Main Methods:
- Review of clinical data for anti-PD-1-based therapies in metastatic melanoma.
- Analysis of published literature on the duration of immunotherapy for melanoma.
- Comparison of response patterns and toxicity risks associated with varying treatment durations.
Main Results:
- Evidence suggests that a full two-year course of anti-PD-1 therapy may not be necessary for all patients.
- Shorter treatment durations could potentially mitigate the risk of immune-mediated toxicities.
- Understanding response mechanisms and kinetics is crucial for optimizing treatment length.
Conclusions:
- Current data indicate a potential for shorter treatment durations with anti-PD-1 therapy in metastatic melanoma.
- Further research is needed to refine treatment duration guidelines and improve patient outcomes.
- Development of novel biomarkers and monitoring tools is essential for personalized therapy management.
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