Efficacy of nivolumab in advanced melanoma

Check-point inhibitors are new agents that has significantly improved clinical outcomes in treatment of advanced melanoma treatment. Ipilimumab was the first agent that increased overall survival of pretreated patients with advanced melanoma. Nivolumab is PD-1 inhibitor, studied in three trials of 3rd phase at the dose 3 mg/kg IV every 2 weeks. Nivolumab monotherapy has median OS equal to 37,6 months, Median OS of nivolumab plus ipilimumab has not been reached in minimum follow up of 36 months. 3 years OS is 58% in combination group and 52% in nivolumab group compared to 34% in ipilimumab group. ORR was 45% in nivolumab group and 58% in combination group. In patients with low expression of PD-L1 and BRAF MT combination of nivolumab and ipilimumab has better outcomes. Nivolumab is well tolerated, grade 3-4 adverse reactions amount to 10% in pooled analysis. Grade 3-4 adverse reactions showed 55% in combination of nivolumab plus ipilimumab; however, no new types of reactions reported. Majority of adverse reactions were resolved in 3-4 weeks by using special guidelines of adverse reactions management. PD-1 inhibitors, including nivolumab in monotherapy and in combination with ipilimumab become new standard of care for advance melanoma regardless of BRAF status and PD-L1.