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Posted by on Oct 20, 2019 in Melanoma | 0 comments

In a nutshell

This study compared nivolumab (Opdivo) plus ipilimumab (Yervoy) to either drug alone for the treatment of advanced melanoma. The authors concluded that nivolumab plus ipilimumab or nivolumab alone increased survival compared to ipilimumab alone for these patients.

Some background

Advanced melanoma is a type of skin cancer that can be challenging to treat. Targeted therapies such as nivolumab and ipilimumab have improved treatment outcomes for patients with melanoma. These agents help the body's immune system attack cancer cells. 

Previous studies have shown that combining nivolumab and ipilimumab is more effective for treating melanoma than either drug alone. Some studies have also shown that this combination can be effective for patients with melanoma that has spread to other parts of the body. However, the long-term outcomes of this treatment combination for patients with advanced melanoma are unclear.

Methods & findings

This study involved 945 patients with advanced melanoma. 314 patients nivolumab and ipilimumab. 316 patients received nivolumab alone and 315 patients received ipilimumab alone. The average follow-up time was 60 months. 

On average, patients in the nivolumab plus ipilimumab group went 11.5 months without their disease getting worse or growing. This time was 6.9 months in the nivolumab group and 2.9 months in the ipilimumab group.

Overall survival was longer in the two nivolumab containing groups than in the ipilimumab group. OS refers to the time from start of treatment until the end of life. At 60 month follow up, in the nivolumab plus ipilimumab group, the average overall survival (OS) was over 60 months (the average had not yet been reached). This was 36.9 months in the nivolumab group and 19.9 months in the ipilimumab group. At 5 years, the OS 52%, 44% and 26% in the nivolumab plus ipilimumab, nivolumab and ipilimumab groups respectively. 

Mortality was 48% less likely in the nivolumab plus ipilimumab group compared to the ipilimumab group. Mortality was 37% less likely in patients treated with nivolumab alone than those treated with ipilimumab alone.  

There was no reduction in the patient’s quality of life when treated with nivolumab plus ipilimumab or nivolumab alone. In addition, no new toxic effects were noted at 5 years. Treatment-related side effects occurred in 59% of the nivolumab plus ipilimumab group, 23% of the nivolumab group and 28% of the ipilimumab group.

The bottom line

This study concluded that nivolumab plus ipilimumab or nivolumab alone led to better long-term outcomes in patients with advanced melanoma compared to ipilimumab alone.

The fine print

This study was funded by Bristol-Myers Squibb, the manufacturer of both of the study drugs.

What’s next?

Talk to your oncologist about whether this treatment might be suitable for you.

Published By :

The New England Journal of Medicine

Date :

Sep 28, 2019

Original Title :

Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma.

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