Dr. Sharpless on Managing Toxicities With Nivolumab and Ipilimumab in Melanoma

Norman E. Sharpless, MD, professor of Medicine and Genetics, chair, the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center, UNC School of Medicine, discusses how oncologists can best manage toxicities associated with the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for the treatment of patients with melanoma.

Oncologists are becoming more familiar with the toxicities associated with ipilimumab, which include grade 3/4 that requires treatment with steroids, Sharpless explains. Nivolumab is generally well tolerated among patients, he adds, though pneumonitis is a mild associated toxicity. The combination of nivolumab and ipilimumab is substantially more toxic than either immunotherapy agent alone, Sharpless adds. Treatment-related deaths occurred from apophysitis; hepatic and gastrointestinal toxicities can also be severe.

Patients treated with the combination should be closely monitored for autoimmune side effects. However, most toxicities are experienced by patients upfront; therefore, oncologists and patients should not expect these adverse events later on in their treatment plan.