[Could the administration of immune checkpoint inhibitors be discontinued after 2 years of application? Pros and cons for the development of a national guideline.]

Abstract

Despite their undeniable effectiveness, the spectacular increase in the number of antitumor immunotherapies (IT) in recent years has resulted in a substantial organizational and financial challenge on healthcare systems, and prolonged treatments can be burdensome for patients as well. There is an ongoing debate about how long it is optimal to continue palliative IT, or it can be discontinued after 2 years without an increased risk of relapse. Conclusively, it could be especially justified in complete tumor remission, however stable disease does not preclude it, and the decision may be strengthened by chronic complications, comorbidity state, patient preference, and PET/CT negativity, double IT, and lack of prior oligo- progression. Nevertheless, all this requires individual consideration, tumor-board discussion, and it is recommended to gradually prepare patients psychologically. In summary, while maintaining the possibility of reinduction, the discontinuation of palliative IT should always be considered after 2 years application (even after 1 year in melanoma), aiming for the longest treatment-free survival of our patients and minimizing the feeling of having a chronic and incurable disease.