Purpose of review: Only a subset of melanoma patients with advanced disease seems to benefit from immunotherapy. Predictive markers identifying these patients are unfortunately not available. Whether immune-related side effects could serve as predictors for treatment response or just resemble unwanted side effects from immunotherapy will be outlined in this review. Recent findings: Early studies suggested an association of immune-related side effects such as vitiligo and autoimmune thyroiditis with response in patients receiving IL-2 or IFNα. However, conflicting data have been reported as well, mentioning the effect of a higher rate of immune-related toxicities during prolonged administration of the drug in responders/survivors. This type of bias is also known as guarantee-time bias. Recently, a clearly significant and clinically relevant prolongation of survival was demonstrated in patients with metastatic melanoma treated with ipilimumab. Immune-related adverse events were associated with response to ipilimumab, however, at the cost of considerable toxicity. Summary: Evidence for an association of immune-related toxicities and response in patients receiving IL-2 or IFNα is weak, considering guarantee-time bias. On the contrary, this association for patients receiving anti-cytotoxic T-lymphocyte antigen-4 therapy (ipilimumab) appears much stronger. Importantly, can we uncouple tumor immunity from autoimmunity in order to optimize immunotherapy in melanoma?

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Keywords IL-2, anti-CLTA-4, autoimmunity, immune-related adverse event, immunotherapy, interferon, melanoma, prognostic factor
Persistent URL dx.doi.org/10.1097/CCO.0b013e328341edff, hdl.handle.net/1765/23852
Journal Current Opinion in Oncology
Bouwhuis, M.G, ten Hagen, T.L.M, Suciu, S, & Eggermont, A.M.M. (2011). Autoimmunity and treatment outcome in melanoma. Current Opinion in Oncology, 23(2), 170–176. doi:10.1097/CCO.0b013e328341edff