How do you approach restarting immunotherapy in a patient with metastatic melanoma who previously developed immune-mediated hepatitis (Grade 3), with liver enzymes now back to baseline levels?  

I prefer to rechallenge when the irAE is back to grade 0. It depends on how long the hepatitis took to revert to a normal level. If it goes back to normal quickly (within 4 weeks), I keep patients on 8 mg methylprednisolone when rechallenging patients. If they do well, I wean them off at the secon...

This is a great question that we do not have a definite answer to. Are you restarting the same immunotherapy? Or different? If the hepatitis is due to Ipilimumab-- I am unsure how best to prevent it. These are the options I think about when I am asked about these patients in clinical practice- We...

Did the patient have elevated AST/ALT only or accompanied by an elevation in T. bili? I think the likelihood of recurrence of severe hepatitis is high if the patient is rechallenged with a similar treatment regime. If this develops when the patient is on dual immune checkpoint therapy (i.e., ipi/niv...

It depends on what he got in the first-line setting. Also depends on what level of metastasis we are talking about. Brain mets? Liver mets? Those are critical questions before someone can answer. Usually, we have reintroduced immunotherapy (mostly anyi-PD1 monotherapy) in such patients without recur...