Dr. Postow on Advancements of Immunotherapy in Melanoma

Michael A. Postow, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses some of the exciting advancements seen with immunotherapy in the treatment of patients with melanoma.

Now that oncologists have seen promising results with these different agents, the question that remains is how to sequence them, says Postow. Thus far, pembrolizumab (Keytruda) and nivolumab (Opdivo) have demonstrated impressive efficacy as single agents for patients with advanced melanoma, and both have received FDA approvals in this setting. In 1 trial, patients treated with pembrolizumab had an overall response rate (ORR) of 33%, compared with 12% for ipilimumab (Yervoy). The approval of nivolumab was based on a randomized clinical trial where the ORR was 32% in patients who received the immunotherapy agent.

As a single agent, ipilimumab is approved as a second-line treatment, as well as adjuvant therapy for patients with completely resected melanoma. The combination of ipilimumab and nivolumab has demonstrated significant promise as well, and was approved by the FDA in 2015 for previously untreated unresectable or metastatic melanoma for patients without a BRAF mutation. Patients receiving the combination had an objective response rate of 50%, compared with 40% for nivolumab and 14% for ipilimumab—an increase greater than either drug alone. The FDA has since expanded this approval to include treating melanoma regardless of mutational status.

There are several ongoing trials assessing the efficacy of other checkpoint inhibitors, including durvalumab, atezolizumab (Tecentriq), and avelumab, among others.