Dual immunotherapy in advanced melanoma

In this video, Prof Dr Bart Neyns speaks with Prof Dr Georgina Long to discuss updated 5-year data from RELATIVITY-047 and an indirect comparison between nivolumab plus relatlimab and nivolumab plus ipilimumab in advanced melanoma.^1,2

With longer follow-up, nivolumab plus relatlimab continued to show durable benefit over nivolumab monotherapy, with maintained improvements in progression-free survival, overall survival, melanoma-specific survival and objective response rate. At 5 years, absolute landmark differences in favour of nivolumab plus relatlimab were 10% for progression-free survival, 10% for overall survival and 13% for melanoma-specific survival, while safety remained consistent with prior reports.¹

An updated indirect treatment comparison suggested broadly comparable efficacy between nivolumab plus relatlimab and nivolumab plus ipilimumab, although results should be interpreted cautiously because of cross-trial differences and changes in melanoma management over time. Subgroup trends suggested that some patients, including those with BRAF-mutant disease, high LDH, acral or mucosal melanoma, may still derive particular benefit from CTLA-4-based therapy.²

The discussion also highlights the importance of toxicity management with combination immunotherapy. In the indirect comparison, nivolumab plus relatlimab was associated with lower rates of grade 3-4 treatment-related adverse events than nivolumab plus ipilimumab.² However, the experts note that CheckMate 067 was conducted earlier, when clinicians had less experience with immune-related adverse event management, which may have contributed to higher reported toxicity rates with nivolumab plus ipilimumab. Careful monitoring, early treatment interruption and individualised rechallenge decisions remain essential in daily practice.