Nivolumab plus Ipilimumab in Advanced Melanoma.
By: Jedd D Wolchok, Harriet Kluger, Margaret K Callahan, Michael A Postow, Naiyer A Rizvi, Alexander M Lesokhin, Neil H Segal, Charlotte E Ariyan, Ruth-Ann Gordon, Kathleen Reed, Matthew M Burke, Anne Caldwell, Stephanie A Kronenberg, Blessing U Agunwamba, Xiaoling Zhang, Israel Lowy, Hector David Inzunza, William Feely, Christine E Horak, Quan Hong, Alan J Korman, Jon M Wigginton, Ashok Gupta, Mario Sznol

From the Ludwig Center, Memorial Sloan-Kettering Cancer Center, New York (J.D.W., M.K.C., M.A.P., N.A.R., A.M.L., N.H.S., C.E.A., R.-A.G., S.A.K., B.U.A.); Yale University School of Medicine and Smilow Cancer Center, Yale-New Haven Hospital, New Haven, CT (H.K., K.R., M.M.B., A.C., M.S.); Dako North America, Carpinteria (X.Z.), and Bristol-Myers Squibb, Redwood City (A.J.K.) - both in California; and Bristol-Myers Squibb, Princeton, NJ (I.L., H.D.I., W.F., C.E.H., Q.H., J.M.W., A.G.).
2013-6-4; doi: 10.1056/NEJMoa1302369
Abstract

Background In patients with melanoma, ipilimumab (an antibody against cytotoxic T-lymphocyte-associated antigen 4 [CTLA-4]) prolongs overall survival, and nivolumab (an antibody against the programmed death 1 [PD-1] receptor) produced durable tumor regression in a phase 1 trial. On the basis of their distinct immunologic mechanisms of action and supportive preclinical data, we conducted a phase 1 trial of nivolumab combined with ipilimumab in patients with advanced melanoma. Methods We administered intravenous doses of nivolumab and ipilimumab in patients every 3 weeks for 4 doses, followed by nivolumab alone every 3 weeks for 4 doses (concurrent regimen). The combined treatment was subsequently administered every 12 weeks for up to 8 doses. In a sequenced regimen, patients previously treated with ipilimumab received nivolumab every 2 weeks for up to 48 doses. Results A total of 53 patients received concurrent therapy with nivolumab and ipilimumab, and 33 received sequenced treatment. The objective-response rate (according to modified World Health Organization criteria) for all patients in the concurrent-regimen group was 40%. Evidence of clinical activity (conventional, unconfirmed, or immune-related response or stable disease for ≥24 weeks) was observed in 65% of patients. At the maximum doses that were associated with an acceptable level of adverse events (nivolumab at a dose of 1 mg per kilogram of body weight and ipilimumab at a dose of 3 mg per kilogram), 53% of patients had an objective response, all with tumor reduction of 80% or more. Grade 3 or 4 adverse events related to therapy occurred in 53% of patients in the concurrent-regimen group but were qualitatively similar to previous experience with monotherapy and were generally reversible. Among patients in the sequenced-regimen group, 18% had grade 3 or 4 adverse events related to therapy and the objective-response rate was 20%. Conclusions Concurrent therapy with nivolumab and ipilimumab had a manageable safety profile and provided clinical activity that appears to be distinct from that in published data on monotherapy, with rapid and deep tumor regression in a substantial proportion of patients. (Funded by Bristol-Myers Squibb and Ono Pharmaceutical; ClinicalTrials.gov number, NCT01024231 .).





PMID:23724867






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