Combination Immunotherapy Strategies in Melanoma: Insights From Key Trials
Panelists discuss how 2 key clinical trials, Checkmate 067 and RELATIVITY-047, established the efficacy of different immunotherapy combinations while highlighting the significant difference in toxicity profiles between ipilimumab plus nivolumab (60% grade 3/4 toxicity) versus relatlimab plus nivolumab (19% grade 3/4 toxicity).
EP: 1.The Evolving Treatment Paradigm in Melanoma: Targeted Therapy vs Immunotherapy
EP: 2.Frontline Treatment Options for Melanoma
EP: 3.Clinical Perspectives: Single-Agent Vs Combination Immunotherapy for Melanoma
EP: 4.Combination Immunotherapy Strategies in Melanoma: Insights From Key Trials
Comparing Combination Immunotherapy Options
Key Discussion Points:
- Two major combination therapy options: nivolumab plus ipilimumab (CheckMate 067) and nivolumab plus relatlimab (RELATIVITY-047)
- Different primary end points and toxicity profiles between the 2 pivotal trials
- Indirect treatment comparison analysis suggests similar efficacy between the combinations
Key Points for Physicians:
- CheckMate 067 demonstrated overall survival benefit for ipilimumab plus nivolumab vs monotherapy, with 10-year follow-up showing durable responses (43% OS, approximately 55% melanoma-specific survival)
- RELATIVITY-047 showed doubling of median PFS with nivolumab/relatlimab vs nivolumab alone (primary end point), with significantly less toxicity than ipilimumab combinations
- Grade 3-4 toxicity rates differ substantially: >60% with ipi/nivo vs approximately 19% with rela/nivo
Notable Insights:
An indirect treatment comparison analysis published in the Journal of Clinical Oncology used individual patient data from both pivotal trials and found no statistically significant differences in PFS or OS between nivolumab/ipilimumab and nivolumab/relatlimab, providing reassurance about the efficacy of both regimens.
Clinical Significance:
While both combination immunotherapy regimens demonstrate efficacy advantages over monotherapy, their significantly different toxicity profiles offer clinicians important options for tailoring treatment to individual patient characteristics.
