Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus study
Anti-programmed death (ligand) 1 (anti-PD-(L)1) therapies were first introduced in the metastatic setting and have since been approved and reimbursed for treating early-stage cancers in the adjuvant, perioperative, and neoadjuvant settings in many cancer types. Current evidence supporting anti-PD(L)...
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| Language: | English |
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BMJ Publishing Group
2025-05-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/13/5/e011184.full |
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| author | Christos Chouaïd Lajos Pusztai Federico Cappuzzo Phillip Parente Robert Jones Vernon K Sondak Masayoshi Nagata Raquel Aguiar-Ibáñez Yosuke Hirasawa Ryuichi Mizuno Smita Kothari Carmel Spiteri Alexander Sun Chris Elder Masaru Ishida Seung Hyeun Lee David Okonji Bhavesh Shah Dominihemberg Ferreira Andrea Lauer Amrit Kaliasethi Carol Kao Jan McKendrick |
| author_facet | Christos Chouaïd Lajos Pusztai Federico Cappuzzo Phillip Parente Robert Jones Vernon K Sondak Masayoshi Nagata Raquel Aguiar-Ibáñez Yosuke Hirasawa Ryuichi Mizuno Smita Kothari Carmel Spiteri Alexander Sun Chris Elder Masaru Ishida Seung Hyeun Lee David Okonji Bhavesh Shah Dominihemberg Ferreira Andrea Lauer Amrit Kaliasethi Carol Kao Jan McKendrick |
| author_sort | Christos Chouaïd |
| collection | DOAJ |
| description | Anti-programmed death (ligand) 1 (anti-PD-(L)1) therapies were first introduced in the metastatic setting and have since been approved and reimbursed for treating early-stage cancers in the adjuvant, perioperative, and neoadjuvant settings in many cancer types. Current evidence supporting anti-PD(L)-1 retreatment after relapse with prior neoadjuvant and/or adjuvant anti-PD(L)1 therapy is limited and inconclusive. There is no guidance for clinicians on how and when to retreat with anti-PD-(L)1 therapies when anti-PD-(L)1 therapy was administered in the neoadjuvant and/or adjuvant setting. This study aimed to reach consensus on factors to guide decision-making regarding retreatment with anti-PD-(L)1 therapies after prior therapy with an anti-PD-(L)1 agent. This modified Delphi study consisted of a clinician survey across 10 countries followed by three real-time virtual Delphi panels involving clinical experts who had completed the survey. Clinical experts were experienced in using anti-PD-(L)1 treatments in early-stage cancers and/or as retreatment of patients with recurrences following early-stage treatment with anti-PD-(L)1 therapies. Of 28 clinicians providing survey responses, 20 participated in one of three Delphi panels. There was consensus that retreatment can be defined as ‘repeated treatment with the same therapeutic class following relapse after or during neoadjuvant and/or adjuvant treatment.’ All three panels agreed that decisions around retreatment should consider ‘prior immune-related adverse events/toxicity,’ ‘time-related factors’ (eg, time since completion of full treatment course and since discontinuation) and ‘previous patient response’ (often referred to by clinicians as tumor response, which may have reflected their experience with metastatic disease). Other factors identified as important included country-specific practices, treatment availability, and reimbursement. Generally, the clinical experts considered that retreatment could be considered from ≥3 to 6 months after stopping initial anti-PD-(L)1 treatment, or from ≥6 months after relapse/recurrence. In conclusion, clinicians across different regions recognized a role for retreating patients with anti-PD-(L)1 therapies after initial anti-PD-(L)1 treatment for early-stage cancers. Consensus was reached on some factors to consider regarding whether and when to retreat, although differences in clinical practice between countries/geographical regions made it difficult to achieve consensus for some more nuanced elements of retreatment. Further evidence could help better inform retreatment decisions. |
| format | Article |
| id | doaj-art-e749df6fbecd48849435c88dc52c21e7 |
| institution | DOAJ |
| issn | 2051-1426 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj-art-e749df6fbecd48849435c88dc52c21e72025-08-20T03:12:12ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262025-05-0113510.1136/jitc-2024-011184Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus studyChristos Chouaïd0Lajos Pusztai1Federico Cappuzzo2Phillip Parente3Robert Jones4Vernon K Sondak5Masayoshi Nagata6Raquel Aguiar-Ibáñez7Yosuke Hirasawa8Ryuichi Mizuno9Smita Kothari10Carmel Spiteri11Alexander Sun12Chris Elder13Masaru Ishida14Seung Hyeun Lee15David Okonji16Bhavesh Shah17Dominihemberg Ferreira18Andrea Lauer19Amrit Kaliasethi20Carol Kao21Jan McKendrick22CHI Créteil Hospital, Créteil, FranceYale University Yale Cancer Center, New Haven, Connecticut, USAIstituto Nazionale Tumori IRCCS Regina Elena, Rome, ItalyMonash University Eastern Health Clinical School, Melbourne, Victoria, AustraliaUniversity of Glasgow, Glasgow, UKMoffitt Cancer Center, Tampa, Florida, USADepartment of Urology, Juntendo University Hospital, Tokyo, JapanMerck Canada Inc, Kirkland, Quebec, CanadaTokyo Medical University, Tokyo, JapanKeio University Hospital, Tokyo, JapanMerck & Co Inc, Rahway, New Jersey, USAMSD Australia, Macquarie Park, New South Wales, AustraliaPrincess Margaret Cancer Centre, Toronto, Ontario, CanadaFlorida Cancer Specialists and Research Institute, Tampa, Florida, USASaiseikai Yokohamashi Tobu Hospital, Yokohama, JapanDepartment of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)Bowen Icon Cancer Centre and Wellington Regional Hospital, Wellington, New ZealandBoston Medical Center, Boston, Massachusetts, USAMSD Brasil, São Paulo, BrazilMSD International GmBH (Singapore branch), SingaporeAvalere Health, London, UKAvalere Health, SingaporeAvalere Health, London, UKAnti-programmed death (ligand) 1 (anti-PD-(L)1) therapies were first introduced in the metastatic setting and have since been approved and reimbursed for treating early-stage cancers in the adjuvant, perioperative, and neoadjuvant settings in many cancer types. Current evidence supporting anti-PD(L)-1 retreatment after relapse with prior neoadjuvant and/or adjuvant anti-PD(L)1 therapy is limited and inconclusive. There is no guidance for clinicians on how and when to retreat with anti-PD-(L)1 therapies when anti-PD-(L)1 therapy was administered in the neoadjuvant and/or adjuvant setting. This study aimed to reach consensus on factors to guide decision-making regarding retreatment with anti-PD-(L)1 therapies after prior therapy with an anti-PD-(L)1 agent. This modified Delphi study consisted of a clinician survey across 10 countries followed by three real-time virtual Delphi panels involving clinical experts who had completed the survey. Clinical experts were experienced in using anti-PD-(L)1 treatments in early-stage cancers and/or as retreatment of patients with recurrences following early-stage treatment with anti-PD-(L)1 therapies. Of 28 clinicians providing survey responses, 20 participated in one of three Delphi panels. There was consensus that retreatment can be defined as ‘repeated treatment with the same therapeutic class following relapse after or during neoadjuvant and/or adjuvant treatment.’ All three panels agreed that decisions around retreatment should consider ‘prior immune-related adverse events/toxicity,’ ‘time-related factors’ (eg, time since completion of full treatment course and since discontinuation) and ‘previous patient response’ (often referred to by clinicians as tumor response, which may have reflected their experience with metastatic disease). Other factors identified as important included country-specific practices, treatment availability, and reimbursement. Generally, the clinical experts considered that retreatment could be considered from ≥3 to 6 months after stopping initial anti-PD-(L)1 treatment, or from ≥6 months after relapse/recurrence. In conclusion, clinicians across different regions recognized a role for retreating patients with anti-PD-(L)1 therapies after initial anti-PD-(L)1 treatment for early-stage cancers. Consensus was reached on some factors to consider regarding whether and when to retreat, although differences in clinical practice between countries/geographical regions made it difficult to achieve consensus for some more nuanced elements of retreatment. Further evidence could help better inform retreatment decisions.https://jitc.bmj.com/content/13/5/e011184.full |
| spellingShingle | Christos Chouaïd Lajos Pusztai Federico Cappuzzo Phillip Parente Robert Jones Vernon K Sondak Masayoshi Nagata Raquel Aguiar-Ibáñez Yosuke Hirasawa Ryuichi Mizuno Smita Kothari Carmel Spiteri Alexander Sun Chris Elder Masaru Ishida Seung Hyeun Lee David Okonji Bhavesh Shah Dominihemberg Ferreira Andrea Lauer Amrit Kaliasethi Carol Kao Jan McKendrick Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus study Journal for ImmunoTherapy of Cancer |
| title | Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus study |
| title_full | Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus study |
| title_fullStr | Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus study |
| title_full_unstemmed | Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus study |
| title_short | Clinical factors influencing retreatment with anti-PD-(L)1 therapies after treatment in early-stage cancers: a modified Delphi consensus study |
| title_sort | clinical factors influencing retreatment with anti pd l 1 therapies after treatment in early stage cancers a modified delphi consensus study |
| url | https://jitc.bmj.com/content/13/5/e011184.full |
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