Management of Advanced Solid Tumors Recurring After Adjuvant Immune Checkpoint Inhibitors: A Structured Narrative Review
TL;DR
Uniform timing definitions, an explicit hierarchy separating direct evidence from extrapolation, and tumor-specific rather than universal rules for checkpoint inhibitor re-exposure are proposed for checkpoint inhibitor re-exposure.
Abstract
Simple Summary When cancer returns after immune checkpoint inhibitor treatment given around curative surgery, clinicians often have little direct evidence to guide the next therapy. This review examines melanoma, non-small-cell lung cancer, renal cell carcinoma, urothelial carcinoma, and triple-negative breast cancer. A short interval to recurrence is consistently associated with poorer outcomes, but it does not identify one resistance mechanism or reliably predict benefit from a specific treatment. Decisions should also consider tumor type, disease extent and sites, molecular findings, previous immune-related toxicity, comorbidities, patient preference, and treatment access. Direct post-adjuvant evidence is strongest in melanoma and remains limited in the other tumors. We therefore propose uniform timing definitions, an explicit hierarchy separating direct evidence from extrapolation, and tumor-specific rather than universal rules for checkpoint inhibitor re-exposure.