Early Effects of Nivolumab and Ipilimumab Combined Immunotherapy in the Treatment of Metastatic Melanoma in Poland: A Multicenter Experience

Abstract

Nivolumab and ipilimumab combination became the first-line standard in advanced melanoma. We assessed its efficacy in a real-life study in Poland. In a one-year follow-up, we evaluated the medical records of 50 melanoma patients treated with that modality in five oncology centers. We recorded therapy outcomes and adverse events (AEs) after 3 and 12 months of therapy. At the first checkpoint, the disease control rate (DCR) was recorded in 58% (n = 29) of patients, but the same number of patients (n = 29, 58%) stopped immunotherapy due to disease progression (PD, n = 14, 48.3%), toxicity (n = 11, 37.9%) or death (n = 4, 13.8%). Among patients with DCR after the induction phase, 8 (27.6%) terminated due to toxicity, and 21 (72.4%) continued. However, at the 12-month checkpoint, only 14 patients (27% of all) were still receiving immunotherapy. In 7 (33.3%) it was discontinued due to PD (n = 2), toxicity (n = 2, 28.6% each), or death (n = 3, 42.9%). AEs occurred in 66.7% (n = 34) of patients; severe (grade 3 or 4) in half of them. Interestingly, those with AEs had an 80% lower risk of death (hazard ratio [HR] 0.2, 95% confidence interval [CI] 0.07–0.57, p = 0.001) and PD (HR 0.2, 95%CI 0.09–0.47, p < 0.0001). In the entire group of patients, after a 12-month follow-up, the median overall survival was not reached (NR, range: 6.8 months-NR) and progression-free survival was 6.3 (range: 3-NR) months. Our results demonstrate that combined immunotherapy is less effective in real-life than in pivotal trials. However, early responders will likely continue the therapy after a one-year follow-up. AEs occurrence might be a predictor of clinical effectiveness.

Immune Checkpoint Inhibitor Related Rheumatological Complications: Cooperation between Rheumatologists and Oncologists

“…There is a rationale for considering irAEs as a predictive factor for oncological responses. To date, several studies have revealed a correlation between irAEs and better survival [ 79 , 91 , 92 , 93 ]. In our real-life report, melanoma patients treated with combined immunotherapy who experienced irAEs had an 80% lower risk of death (hazard ratio (HR) 0.2, 95% CI 0.07–0.57, p = 0.001) and disease progression (HR 0.2, 95% CI 0.09–0.47, p < 0.0001) [ 93 ].…”

“…To date, several studies have revealed a correlation between irAEs and better survival [ 79 , 91 , 92 , 93 ]. In our real-life report, melanoma patients treated with combined immunotherapy who experienced irAEs had an 80% lower risk of death (hazard ratio (HR) 0.2, 95% CI 0.07–0.57, p = 0.001) and disease progression (HR 0.2, 95% CI 0.09–0.47, p < 0.0001) [ 93 ]. In another major study of 1747 patients with metastatic or locally advanced urothelial cancer treated with anti-PD-1/PD-L1 antibodies, irAEs were reported in 28% of responders vs. 12% of non-responders [ 92 ].…”