Kristen N. Ganjoo, MD: I’ve been using a lot of immunotherapy over the past year, based on the Alliance trial with ipilimumab/nivolumab versus nivolumab. I’ve had some very good responses, some CRs and some really good patients-coming-out-of-hospice responses, right? But I still have to figure out which patients those are. Giving 40 patients immunotherapy, with 5 of them having a great response, we just need to know which patients are going to respond and which patients will not. We don’t have that marker yet.

William D. Tap, MD: Definitely consider the clinical trial; definitely understand the histological subtype and when to use it. I think these aren’t tumors that are going to follow predictors in other diseases. We are only learning about PD-1. We’re only learning about the tumor microenvironment and whether or not tumors are hot or cold. Will they be responsive? How do you use it in your practice? Is it clearly a clinical trial thing?

Richard F. Riedel, MD: I do not routinely recommend off-label use for immunotherapy. I do it in the context of a clinical trial. I just think we need the data. The SARC028 study showed a 40% response rate for undifferentiated pleomorphic sarcoma, but a 20% response rate for liposarcomas. There were 10 patients per cohort. To me, that’s not enough to routinely advocate for off-label use. At least at our institution, we don’t do it.

Victor M. Villalobos, MD, PhD: But regarding single-agent pembrolizumab, atezolizumab, or other PD-1/PD-L1 inhibitors, they’re very tolerable therapies. If you can get them off-label, I think it may be worthwhile, particularly if patients respond.

Richard F. Riedel, MD: It’s clear that it’s not the homerun that it is in melanoma, lung cancer, or other diseases.

William D. Tap, MD: We have a community, but they haven’t figured it out yet, right?

Kristen N. Ganjoo, MD: Yes. What would the patient say to you? What if there’s no clinical trial that they qualify for? What if that patient is going to be the one who responds to immunotherapy? Those are also important things to figure out.

Transcript Edited for Clarity