Combination of targeted and immune therapy- discussion between Ribas and Flaherty

Ribas-

'The ultimate targeted therapy: Your own antitumor T-cells'

Nice overview comparing targeted and immune therapy:


Interesting argumentation to give checkpoint blockage before targeted (BRAF and MEKi) therapy.

Contrary to common belief, patients with high LDH also profit less from targeted therapy but can respond to anti-PD1.

Why give checkpoint blockage before BRAFi plus MEKi- it seems that acquired resistance also confers resistance to PD1 blockage.

and Ribas' conclusion:

Flaherty

And yet again- No patients should be getting BRAF monotherapy-

And an interesting algorithm on how to identify patients at higher risk, based on LDH level and the number of disease sites- patients will normal LDH and less than disease sites do best.

So the discussion which therapy to start with and how to continue is far from resolved but the possible cross-resistance between targeted therapy and immune therapy is something to worry about.