Two checkpoint inhibitor combinations in patients with cutaneous melanoma: A systematic review of clinical trials.

Authors

null

Wajeeha Aiman

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Wajeeha Aiman , Mati Ullah Dad Ullah , Mukarram Jamat Jamat Ali , Iman Waheed Khan , Mina Choudhry , Hafsa Chaudry , Aqsa Anwar , sreekant avula , Faiz Anwer , Muhammad Ashar Ali

Organizations

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, King Edward Medical University, Lahore, Pakistan, Ameer ud din Medical College, Lahore, Pakistan, The Wright Center for Graduate Medical Education, Scranton, PA, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH

Research Funding

No funding received

Background: Melanoma is a cancer of melanocytes and has the potential to metastasize to distant organs. Immune checkpoint inhibitors (ICI) enhance the immune response against cancer cells. Programmed cell death protein-1 (PD-1), PD-ligand-1 (PD-L1), cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), and lymphocyte-activation gene (LAG-3) are the common targets of ICI. Blocking two pathways can have an additive/synergistic effect. This systematic review will assess the efficacy of two ICI combinations in cutaneous melanoma. Methods: A search was performed on PubMed, Embase, and clinicaltrials.gov. We used the following mesh and Emtree terms, “Melanoma” AND “Immune checkpoint inhibitors,” from the inception of literature till 01/15/2022. We screened 11,287 articles and included 4 randomized clinical trials (N = 1,948) and 6 single-arm clinical trials (N = 438) in this review. We excluded preclinical trials, case reports, case series, review articles, observational studies, meta-analysis, and irrelevant clinical trials. Results: In 10 clinical studies (N = 2,386), two ICI combinations were assessed in adult patients with melanoma. Nivolumab (nivo) + ipilimumab (ipi), relatlimab (rela) + nivo, pembrolizumab (pemb) + ipi, lag525 + spartalizumab (spa), fianlimab (fian) + cemiplimab (cem) and single drug/placebo were used to treat 560, 365, 223, 42, 48, and 1,148 patients, respectively. 2,119, 70, and 197 patients had advanced untreated, PD-1/L1 refractory, and resectable stage III/IV melanoma. The response rates (RR) and survival rates are given in table. Conclusions: Two ICI combinations of nivo, ipi, and rela were more effective than monotherapy in patients with untreated advanced melanoma. In early phase trials, combinations of ipi, nivo, pemb, lag525, spa, fian, and cem were effective in advanced melanoma. Nivo, ipi, and rela were effective in patients with resectable melanoma. Pemb+ipi was effective in patients with PD-1/L1 refractory melanoma. More randomized double-blinded clinical trials are needed to confirm these results.

Author
Drug (N)
CR
PR
ORR
mPFS
mOS
HR progression/death
Larkin et al. 2015
Nivo+Ipi (314)
11.5%
46.2%
57.6%
11.5
-
0.42 (0.31 to 0.57)
Ipi (315)
2.2%
16.8%
19%
2.9
-
Nivo (316)
8.9%
34.8%
43.7%
6.9
-
0.74 (0.60 to 0.92)
Postow et al. 2015
Nivo+Ipi (95)
22%
37%
59%
-
-
0.40 (0.23 to 0.68)
Ipi (47)
0
11%
11%
-
-
Tawbi et al. 2022

Rela+Nivo (335)
-
-
-
10.1
-
0.76 (0.62–0.92)
Nivo (359)
-
-
-
4.6
-
-
Zimmer et al. 2020 (resected)
Nivo+Ipi (56)
-
-
-
75% (1-yr)
-
0.23 (0.12–0.45) vs. placebo
Nivo (59)
-
-
-
52%
-
-
Placebo (52)
-
-
-
32%
-
-
Long et al. 2017
Pemb+Ipi (153)
-
-
61%
69% (1yr)
89% (1yr)
-
Lin et al. 2020
LAG525+Spa (42)
15%
-
-
2.2
-
-
Amaria et al. 2021 (resectable)
Rela+Nivo (30)
pCR = 59%
-
57%
-
95%
-
Hamid et al. 2021
fian + cemi (48)
8%
40%
48%
-
-
-
Olsen et al. 2021 (PD-1 refractory)
Pemb+Ipi (70)
7%
22%
29%
5
24.7
-
Tawbi et al. 2018 (brain metastasis)
Nivo+Ipi (95)
9%
43%
51%
-
-
-

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Melanoma/Skin Cancers

Track

Melanoma/Skin Cancers

Sub Track

Advanced/Metastatic Disease

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr e21530)

DOI

10.1200/JCO.2022.40.16_suppl.e21530

Abstract #

e21530

Abstract Disclosures

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