Which treatment works best, nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone for advanced melanoma

This study wanted to find out which medications are better for treating advanced melanoma; nivolumab (Opdivo) plus ipilimumab (Yervoy), nivolumab alone, or ipilimumab alone. The study found that using the combination of nivolumab and ipilimumab was more effective than using nivolumab alone, with the least effective treatment being ipilimumab alone.

Nivolumab and ipilimumab are relatively new medications for treatment of advanced melanoma. It is not known if using these medication together, or using them apart, is more effective.

This study consisted of 945 patients. The patients had all been diagnosed with stage 3 or 4 melanoma which was not able to be treated with surgery. The patients were randomly put into three groups. The first group had 314 patients who all received treatment with a combination of nivolumab and ipilimumab. The second group had 316 patients who all received treatment with nivolumab only. The third group had 315 patients who all received treatment with ipilimumab only.

Overall, the group who were treated with a combination of nivolumab and ipilimumab had the best results, followed by the group treated with nivolumab alone. The worst outcomes were from the group treated with ipilimumab only. It was found that 53% of patients who had the combination of medication survived for at least four years after treatment. In comparison, 46% of patients who were treated with nivolumab alone survived for four years. It was found that 30% of patients who were treated with ipilimumab alone survived for four years. After four years, 37% of the patients who received the combined medications survived without progression of the cancer. In comparison, 31% of patients who received nivolumab alone survived for four years without progression of the cancer. Only 9% of patients who received ipilimumab alone survived for four years without progression of the cancer.

The authors found that using a combination of nivolumab and ipilimumab works best for patients with advanced melanoma, followed by nivolumab alone.

This is a fairly large study. It was hard to get statistical significance in some areas of this study because the patients studied in the ipilimumab alone group did not survive long enough.  

Discuss your treatment plan with your oncologist.