Dr. Skarbnik on Combination Strategies of Immunotherapy in Hematologic Malignancies

Alan Skarbnik, MD, staff physician, department of Bone Marrow Transplant, Department of Lymphoma, John Theurer Cancer Center, discusses combination strategies with immunotherapy for patients with hematologic malignancies.

There has been a steady increase in the knowledge of how immune checkpoint inhibitors work, explains Skarbnik. For example, efficacy has been seen with single-agent immunotherapy in patients with a high expression of PD-L1.

However, for patients with multiple myeloma, PD-L1 expression is not as high. This is because the number of T cells infiltrating the myeloma is not as high as other diseases, says Skarbnik. There is significant evidence that PD-L1 inhibitors as single agents are not as efficacious in patients with multiple myeloma.

Physicians are attempting to elicit better response rates by investigating combinations. There are data combining brentuximab vedotin (Adcetris) and nivolumab (Opdivo) as salvage therapy. The response rates seen are higher than either agent alone. However, caution is needed regarding toxicities of these regimens.