What to do in melanoma after anti-PD1 fails or upon regression after a response?

In melanoma world we are lucky to have anti-PD-1 and its 40% response rate.  However, as more of us have taken it, and failed...or even responded...but progressed later....the pressing question becomes...   Now what??????

Here are some articles that attempt to answer...

There was this (with a couple of links within):  ASCO 2016 - Other therapies after failing Pembro...and...trial with OX40 - alone and with Pembro...still enrolling...

And this:  Response to ipi or ipi/nivo after failing anti-PD1 as single agent in Stage IV melanoma

Now there is this case study...

Reinduction of PD1-inhibitor therapy: first experience in eight patients with metastatic melanoma. Blasig, Bender, Hassel, et al. Melanoma Res. 2017 Mar 2.

Significant progress has been made in the treatment of metastatic melanoma during the last years. Approval of immune-checkpoint inhibitors and targeted therapies has been achieved recently. The sequencing of these therapies is an important issue. Here, we report our experience with the treatment and retreatment with PD1-inhibitors (PD1i) in eight patients. The patients (two female and seven male with a median age of 70 years, all melanoma stage IV, M1c) underwent a first treatment period with PD1i for a median of 5.5 months. Three (37.5%) patients had a stable disease as best response, two (25%) showed progression, two (25%) showed partial response, and one (12.5%) achieved complete remission. PD1i was discontinued due to disease progression in seven patients and due to side effects (pancreatitis) in one patient. Patients were subsequently treated with ipilimumab (n=2), or chemotherapy (n=4), or no other medical treatment (n=2). All eight patients were subsequently retreated with PD1i for a median of 2.5 months. One (12.5%) developed a partial response, whereas in three patients (37.5%) the disease was stabilized. PD1i have shown a high and durable response rate in the first-line treatment of metastatic melanoma. Our study suggests PD1i retreatment as a reasonable option for selected patients. Further investigations are needed to verify the value of PD1i re-exposure and to identify subgroups of patients who can benefit.

Well, that's something.  But, too many of us need more!!!  Hang in there ratties!! - c