Short-course nivolumab-ipilimumab shows promise as adjuvant treatment for melanoma

A 6-month course of nivolumab and low-dose ipilimumab appears to be a potential adjuvant treatment for patients with resected melanoma, suggests a study, indicating further research on this regimen.

In this pilot study, the investigators evaluated the safety and toxicity of nivolumab plus low-dose ipilimumab in patients with high-risk completely resected melanoma. Eligible participants received ipilimumab 1 mg/kg every 6 weeks and nivolumab 3 mg/kg every 2 weeks for a total of 24 weeks (4 cycles). Assessment of the toxicity of the combined regimen was the primary objective.

Of the 21 patients with resected melanoma enrolled, one had stage IIC, 16 had stage III, and four had stage IV disease. Nearly half of the patients (48 percent) had grade 3 treatment-related toxicities; no grade 4 or 5 toxicities were recorded. The rate of grade 3 nonhaematologic toxicities surpassed the toxicity limits that were defined by the investigators.

All four cycles of therapy were completed by 15 patients (71 percent). The median follow-up was 41 months. The 2-year recurrence-free survival and overall survival were 85.7 percent and 90.5 percent, respectively.

In a recent study comparing the two agents, nivolumab showed sustained recurrence-free survival benefit relative to ipilimumab in resected stage IIIB-C or IV melanoma, indicating a long-term benefit with nivolumab. Notably, nivolumab remained an efficacious adjuvant treatment for high-risk resected melanoma, with a safety profile that was more tolerable than that of ipilimumab. [Lancet Oncol 2020;21:1465-1477]

“Combined cytotoxic T-lymphocyte-associated antigen 4 and programmed death 1 inhibitor blockade is a promising strategy in advanced melanoma and other solid tumours,” the investigators said.