Comment: Nivolumab-based treatment halts melanoma progression
Dr Steven O'Day - Beverly Hills Cancer Center, Los Angeles, USA
Five years ago I had the pleasure of presenting at the plenary session the initial data with this drug, ipilimumab, the first drug in metastatic melanoma, an immune checkpoint inhibitor, to actually cause long-term survival in about one in four melanoma patients. What we’ve heard today is in five years another checkpoint has been identified called PD1 and several drugs have been identified against that target. So what you heard today was a large randomised study, 900 patients, a global study in metastatic melanoma comparing ipilimumab by itself, the nivolumab, the PD1 drug, by itself or the combination of the two. The take home message is both the PD1 drug by itself, nivolumab, and the combination did much better than ipilimumab.
What’s your take on this finding?
It’s very encouraging and a second finding really is that the combination did better than the PD1 by itself, substantially so in terms of progression free survival. Now it came with an added cost with the combination but there may be a marker now called PDL1 which may be able to identify which patients truly need the combination or which can get away with the PD1 drug by itself, which will be hugely helpful.
So what’s your brief message about what clinicians should make of this right now?
That immunotherapy is front and centre in melanoma at first treatment and PD1 drugs are there and combinations need to be carefully considered based on the data from today’s showing that they may even be better. But a careful discussion with side effects and clinical benefit need to take place between the patient and the doctor.
And how clear is the information from PDL1 expression?
It was remarkably good in this study, not at identifying who gets treatment at all but who would probably benefit from the combination, who needs that, versus who can get away with the PD1 by itself.
A quick bottom line on where this is all going?
We are in a brave new world of immuno-oncology in melanoma and we are now probably producing long-term survival in more than half of patients who have widespread disease. Even more exciting is that these therapies are translating across the board in cancer and I think you have a sense here that the momentum is just palpable in cancer from these drugs.