One recurrent theme regarding melanoma at the recent ESMO 2019 meeting is that Ipi + Nivo improved long-term survival significantly over either agent alone. The side effects as in previous studies were higher, but manageable and did not result in a high number of patients stopping therapy. In fact EVEN if the patient had to stop therapy the benefit of the combination was felt long-term and resulted in improved survival without the need for additional therapies (rescue/salvage).
This falls into the one cycle and done concept that IDRA has promoted with Tilso. That is patients, though perhaps not "cured", can go on with their lives without returning to the hospital/clinics for multiple visits/treatments/procedures. I see a trend that SD is taking on a more important role than in years past where the only attention was given to PR and CR. It also follows the trend of de-emphasizing ORR alone. Since Tilso has had good results with virtually all the approved CPIs pre-clinically and at least with Ipi so far clinically, it stands to reason that the ability to further enhance the tumor microenvironment with a relatively easy intratumoral injection near the time of CPI treatment, could play right in to the current trend for treating Stage III/IV metastatic melanoma without adding complexity or toxicity to the regimen.
The additional abscopal effect may in fact improve outcomes greatly over current therapies. Revving up the immune system and creating tumor fighting memory on a prolonged basis should result in sustained periods where patients can forget about their cancer even if not "cured". This is a concept that I see becoming the new norm as quality of life issues and less expensive, less toxic, and less invasive end-of-life treatments gain momentum. Tilso seems to fit right in to these concepts. Maybe we will even (eventually) make some money along the way.