Dr. Sznol Discusses the Combination of Ipilimumab and Nivolumab in Melanoma

Mario Sznol, MD, professor of medicine, co-director, Yale SPORE in Skin Cancer, Yale Cancer Center, discusses the benefits of immunotherapy, specifically the combination of the CTLA-4 inhibitoripilimumab (Yervoy) and the PD-1 inhibitor nivolumab (Opdivo), in melanoma.

Historically, 5-year overall survival (OS) in this population was 5% to 10%. With the addition of checkpoint inhibitors, that percentage has increased ten-fold to nearly 50%, says Sznol.

However, the risk-benefit ratio with the combination therapy is not as compelling, explains Sznol. As reported in the randomized phase III CheckMate 067 trial, the combination of nivolumab and ipilimumab induced a 4-year OS benefit of 53% versus 46% with nivolumab alone in patients with previously untreated advanced melanoma. Moreover, grade 3/4 treatment-related adverse events,including diarrhea and high levels of lipase, occurred in 59% of patients on the combination compared with 22% on nivolumab alone.

However, Snzol adds, there are some patients in which the combination treatment has shown promise over nivolumab alone including patients with brain metastases, patients with elevated lactate dehydrogenase, and potentially patients with BRAF mutations.