Hi Lisa,
This is a really interesting question. We have not run into this specific scenario at our institution, but if we did encounter it I think our plan would be individualized based on patient tolerance to high dose ipilimumab. For instance, if the patient was tolerating ipi very well with few immune related adverse events, then I think we would complete the 4 doses of high dose ipi. If having mild immune related adverse events, then adjuvant nivo would be considered once those issues improved. If the immune related adverse events were more severe, I suspect we would stop adjuvant therapy altogether and observe the patient very closely for recurrence.
I would love to hear what others think or are doing in this situation.
Virginia