Cost-effectiveness of nivolumab in advanced melanoma: a drug review

ABSTRACT

Introduction: The immune checkpoint inhibitors, including nivolumab, and targeted agents have dramatically improved the outcome for patients with unresectable advanced melanoma.

Areas covered: This is a narrative review of the published evidence on nivolumab in metastatic melanoma.

Expert opinion: In ipilimumab pre-treated patients (CheckMate 037), nivolumab was associated with a higher response rate and a longer duration of response when compared to chemotherapy. In previously untreated patients, nivolumab improves survival when compared to chemotherapy (CheckMate 066) or to ipilimumab (CheckMate 067). The combination of nivolumab and ipilimumab also improves survival when compared to ipilimumab (CheckMate 067). CheckMate 067 was not designed to compare the nivolumab–ipilimumab combination to nivolumab alone. A modified regimen using a lower dose of ipilimumab in combination with standard dose nivolumab is better tolerated than nivolumab in combination with standard dose ipilimumab (CheckMate 511).

In patients with previously untreated metastatic melanoma, the anti-PD-1 monoclonal antibodies nivolumab and pembrolizumab improve survival when compared to ipilimumab. Nivolumab is equally active in BRAF mutated and BRAF wild type melanoma. The optimal sequence of checkpoint inhibitors and BRAF/MEK inhibitors in BRAF mutated patients has not been established.

KEYWORDS:

• Advanced
• anti-PD-1
• checkpoint inhibitors
• melanoma
• metastatic
• nivolumab
• pembrolizumab

Article highlights

• The anti-PD1 antibodies nivolumab and pembrolizumab improve the OS when compared to either dacarbazine or ipilimumab in previously untreated patients with advanced melanoma.

• An unplanned comparison of nivolumab and the combination of nivolumab and ipilimumab suggests that the combination further improves survival albeit at the expense of a significant increase in grade 3 and 4 toxicities.

• The ant-PD1 monoclonal antibodies as single agents are generally well tolerated.

• Immune-related adverse events can occasionally affect any organ of the body.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.