Nivolumab + relatlimab for the treatment of unresectable or metastatic melanoma

ABSTRACT

Introduction

Though melanoma is one of the less common skin malignancies, it accounts for the majority of deaths due to cutaneous cancers. The recent progress and drug approvals in targeted treatment and immunotherapy revolutionized the outcome of patients with metastatic disease, and now is also changing the landscape of adjuvant treatment in melanoma.

Area covered

A combination of anti-PD-1 and anti-CTLA-4 (nivolumab with ipilimumab) has demonstrated superior outcomes in terms of progression-free survival (PFS) and overall survival with recent data confirming median survival exceeding six years. However, the use of this immunotherapy combination is limited in routine practice to approximately half of the patients due to high toxicity with the majority of patients at risk of severe adverse events. The current efforts are to determine how best to integrate combination immunotherapy in different clinical scenarios and limit these drugs’ toxicity. That is why novel strategies in immunotherapy are needed and one of the examples of such novelty are anti-LAG-3 antibodies (lymphocyte-activation gene 3). LAG-3 inhibitor (relatlimab) in combination with nivolumab significantly improved PFS as compared to anti-PD-1 monotherapy in patients with previously untreated metastatic or unresectable melanoma. We describe the current status of combination of nivolumab+ relatlimab in the treatment of advanced melanoma patients based on the available data coming from pivotal clinical trials.

Expert opinion

The most important question to be answered is what would be the place of this novel combination in the treatment planning strategy

KEYWORDS:

• Combination immunotherapy
• Melanoma
• Relatlimab
• Toxicity
• nivolumab

Article highlight

• Recent progress and drug approvals in targeted treatment and immunotherapy revolutionized the outcome of patients with metastatic disease.

• Immunotherapy is the treatment of choice in majority of advanced melanoma patients.

• Combination immunotherapy is more efficient than monotherapy but with a price of high toxicity.

• Clue of modern therapies is to maintain efficacy but lower the toxicity rates.

• Combination of nivolumab and relatlimab represents an attractive option, but still it wouldn’t rather dethrone the combination of nivolumab and ipilimumab.

Potential conflicts of interests

[Anonymized] has received honoraria for lectures and Advisory Boards from BMS, MSD, Novartis, Pierre Fabre, Sanofi, Merck, Astra Zeneca and Philogen outside of the scope of this manuscript.

[Anonymized] has received honoraria for lectures from BMS, MSD, Novartis, Pierre Fabre outside of the scope of this manuscript.

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