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Overall Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma
Open accessAbstract
BACKGROUND: Nivolumab combined with ipilimumab resulted in longer progression-free survival and a higher objective response rate than ipilimumab alone in a phase 3 trial involving patients with advanced melanoma. We now report 3-year overall survival outcomes in this trial. METHODS: We randomly assigned, in a 1:1:1 ratio, patients with previously untreated advanced melanoma to receive nivolumab at a dose of 1 mg per kilogram of body weight plus ipilimumab at a dose of 3 mg per kilogram every 3 weeks for four doses, followed by nivolumab at a dose of 3 mg per kilogram every 2 weeks; nivolumab at a dose of 3 mg per kilogram every 2 weeks plus placebo; or ipilimumab at a dose of 3 mg per kilogram every 3 weeks for four doses plus placebo, until progression, the occurrence of unacceptable toxic effects, or withdrawal of consent. Randomization was stratified according to programmed death ligand 1 (PD-L1) status, BRAF mutation status, and metastasis stage. The two primary end points were progression-free survival and overall survival in the nivolumab-plus-ipilimumab group and in the nivolumab group versus the ipilimumab group. RESULTS: At a minimum follow-up of 36 months, the median overall survival had not been reached in the nivolumab-plus-ipilimumab group and was 37.6 months in the nivolumab group, as compared with 19.9 months in the ipilimumab group (hazard ratio for death with nivolumab plus ipilimumab vs. ipilimumab, 0.55 [P<0.001]; hazard ratio for death with nivolumab vs. ipilimumab, 0.65 [P<0.001]). The overall survival rate at 3 years was 58% in the nivolumab-plus-ipilimumab group and 52% in the nivolumab group, as compared with 34% in the ipilimumab group. The safety profile was unchanged from the initial report. Treatment-related adverse events of grade 3 or 4 occurred in 59% of the patients in the nivolumab-plus-ipilimumab group, in 21% of those in the nivolumab group, and in 28% of those in the ipilimumab group. CONCLUSIONS: Among patients with advanced melanoma, significantly longer overall survival occurred with combination therapy with nivolumab plus ipilimumab or with nivolumab alone than with ipilimumab alone. (Funded by Bristol-Myers Squibb and others; CheckMate 067 ClinicalTrials.gov number, NCT01844505 .).
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“with anti-PD-1 and anti-PD-1/CTLA-4 combination therapy emerging as most effective [3, 4].”
From Relating the gut metagenome and metatranscriptome to immunotherapy responses in melanoma patients (2019) · cites this paper as [4]
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“3-year overall survival rates were 58%, 52%, and 34% in combination therapy, anti-PD-1, and anti-CTLA-4 groups, respectively [4].”
From Relating the gut metagenome and metatranscriptome to immunotherapy responses in melanoma patients (2019) · cites this paper as [4]
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“These chemokines have been identified as the dominant mediators for the recruitment of CXCR3+ and CCR5+ tumor-specific T lymphocytes into the tumors and their intratumoral expression correlated with favorable clinical outcomes in patients with melanoma30–32.”
From Epigenetic state determines the in vivo efficacy of STING agonist therapy (2023) · cites this paper as [30]
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“Third, many of these studies utilized ICIs as monotherapy in a heavily pretreated population whereas current standard first-line therapy often includes a combination of ICIs or ICI with chemotherapy for multiple tumor types (35–40).”
From A Uniform Computational Approach Improved on Existing Pipelines to Reveal Microbiome Biomarkers of Nonresponse to Immune Checkpoint Inhibitors (2021) · cites this paper as [36]
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“By contrast, ICB has shown promise in the adjuvant setting in patients with melanoma or NSCLC57–59”
From Enhancing cancer immunotherapy using antiangiogenics: opportunities and challenges (2018) · cites this paper as [59]
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Self-citationAbu-Sbeih, H., Ali, F. S., Alsaadi, D., Jennings, J., Luo, W., Gong, Z., Richards, D. M., Charabaty, A., & Wang, Y. (2018) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-018-0461-4 · Cited by 215
Emerging strategies for combination checkpoint modulators in cancer immunotherapy
Popović, A., Jaffee, E. M., & Zaidi, N. (2018) · Journal of Clinical Investigation · doi:10.1172/jci120775 · Cited by 209
Noman, M. Z., Hasmim, M., Lequeux, A., Xiao, M., Duhem, C., Chouaı̈b, S., Berchem, G., & Janji, B. (2019) · Cells · doi:10.3390/cells8091083 · Cited by 220
“However, combined therapy with both anti-PD-1 and anti-CTL-A4 significantly improves patient survival [10,11].”
BackgroundAdolescent and Young Adult (AYA) Cancer Survivorship Practices: An Overview
Janssen, S. H. M., van der Graaf, W. T. A., van der Meer, D. J., Manten‐Horst, E., & Husson, O. (2021) · Cancers · doi:10.3390/cancers13194847 · Cited by 216
Dual blockade immunotherapy targeting PD-1/PD-L1 and CTLA-4 in lung cancer
Cheng, W., Kang, K., Zhao, A., & Wu, Y. (2024) · Journal of Hematology & Oncology · doi:10.1186/s13045-024-01581-2 · Cited by 229
Suzman, D. L., Pelosof, L., Rosenberg, A., & Avigan, M. I. (2018) · Liver International · doi:10.1111/liv.13746 · Cited by 189
Bispecific antibodies in cancer immunotherapy
Dahlén, E., Veitonmäki, N., & Norlén, P. (2018) · Therapeutic Advances in Vaccines and Immunotherapy · doi:10.1177/2515135518763280 · Cited by 215
“(1) Cytotoxic effector cell redirectors, including (a) T-cell redirectors (b) NK-cell redirectors (2) Tumor-targeted immunomodulators (3) Dual immunomodulators.”
BackgroundAn expanded universe of cancer targets
Hahn, W. C., Bader, J. S., Braun, T. P., Califano, A., Clemons, P. A., Druker, B. J., Ewald, A. J., Fu, H., Jagu, S., Kemp, C. J., et al. (2021) · Cell · doi:10.1016/j.cell.2021.02.020 · Cited by 213
Immune cell - produced ROS and their impact on tumor growth and metastasis
Kennel, K. B., & Greten, F. R. (2021) · Redox Biology · doi:10.1016/j.redox.2021.101891 · Cited by 213
Immune Checkpoint Inhibitor Therapy in Oncology
Tan, S., Day, D., Nicholls, S. J., & Segelov, E. (2022) · JACC CardioOncology · doi:10.1016/j.jaccao.2022.09.004 · Cited by 219
Abu-Sbeih, H., Ali, F. S., Luo, W., Qiao, W., Raju, G. S., & Wang, Y. (2018) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-018-0411-1 · Cited by 209
Willsmore, Z. N., Coumbe, B. G. T., Crescioli, S., Reci, S., Gupta, A., Harris, R. J. C., Chenoweth, A. M., Chauhan, J., Bax, H. J., McCraw, A. J., et al. (2021) · European Journal of Immunology · doi:10.1002/eji.202048747 · Cited by 216
Melanoma models for the next generation of therapies
Patton, E. E., Mueller, K. L., Adams, D. J., Anandasabapathy, N., Aplin, A. E., Bertolotto, C., Bosenberg, M., Ceol, C. J., Burd, C. E., Chi, P., et al. (2021) · Cancer Cell · doi:10.1016/j.ccell.2021.01.011 · Cited by 219
Treatment after progression in the era of immunotherapy
Billan, S., Kaidar‐Person, O., & Gil, Z. (2020) · The Lancet Oncology · doi:10.1016/s1470-2045(20)30328-4 · Cited by 205
Wu, Q., Qian, W., Sun, X., & Jiang, S. (2022) · Journal of Hematology & Oncology · doi:10.1186/s13045-022-01362-9 · Cited by 208
A TCF4-dependent gene regulatory network confers resistance to immunotherapy in melanoma
Pozniak, J., Pedri, D., Landeloos, E., Van Herck, Y., Antoranz, A., Vanwynsberghe, L., Nowosad, A., Roda, N., Makhzami, S., Bervoets, G., et al. (2024) · Cell · doi:10.1016/j.cell.2023.11.037 · Cited by 199
Self-citationD’Angelo, S. P., Bhatia, S., Brohl, A. S., Hamid, O., Mehnert, J. M., Terheyden, P. A. M., Shih, K. C., Brownell, I., Lebbé, C., Lewis, K. D., et al. (2020) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2020-000674 · Cited by 207
Self-citationExpansion of tumor-associated Treg cells upon disruption of a CTLA-4-dependent feedback loop
Marangoni, F., Zhakyp, A., Corsini, M., Geels, S. N., Carrizosa, E., Thelen, M., Mani, V., Pruessmann, J. N., Warner, R. D., Ozga, A. J., et al. (2021) · Cell · doi:10.1016/j.cell.2021.05.027 · Cited by 209
The Use of Immune Checkpoint Inhibitors in Oncology and the Occurrence of AKI: Where Do We Stand?
Franzin, R., Netti, G. S., Spadaccino, F., Porta, C., Gesualdo, L., Stallone, G., Castellano, G., & Ranieri, E. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.574271 · Cited by 208
Lan, Y., Moustafa, M., Knoll, M., Xu, C., Furkel, J., Lazorchak, A. S., Yeung, T.-L., Hasheminasab, S.-M., Jenkins, M. H., Meister, S., et al. (2021) · Cancer Cell · doi:10.1016/j.ccell.2021.08.008 · Cited by 211
Yang, J., & Hu, L. (2018) · Medicinal Research Reviews · doi:10.1002/med.21530 · Cited by 201
“6 months; 3‐year OS rate: 52%).(150,151) More recently, in the phase 2 trial CheckMate‐142, nivolumab and ipilimumab again exhibited high response rates (55%; 65 of 119 patients) and encouraging PFS (71%) and OS (85%) at 12 months in patients with dMMR/MSI‐H metastatic colorectal cancer.”
BackgroundForschner, A., Battke, F., Hadaschik, D., Schulze, M., Weißgraeber, S., Han, T., Kopp, M., Frick, M., Klumpp, B. D., Tietze, N., et al. (2019) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-019-0659-0 · Cited by 215
Human Anti-tumor Immunity: Insights from Immunotherapy Clinical Trials
Egen, J. G., Ouyang, W., & Wu, L. C. (2020) · Immunity · doi:10.1016/j.immuni.2019.12.010 · Cited by 198
Adoptive transfer of tumor-infiltrating lymphocytes in melanoma: a viable treatment option
Rohaan, M. W., van den Berg, J. H., Kvistborg, P., & Haanen, J. B. A. G. (2018) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-018-0391-1 · Cited by 204
“Treatment with PD-1 blockade, or an anti-PD-1-based combination, is now mostly first-line therapy in patients with advanced melanoma, showing an unprecedented 3-year overall survival around 50% [4].”
BackgroundSelf-citationThe Immune Subtypes and Landscape of Squamous Cell Carcinoma
Li, B., Cui, Y., Nambiar, D. K., Sunwoo, J. B., & Li, R. (2019) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-18-4085 · Cited by 199
“In particular, immune 53 checkpoint blockade (ICB) such as anti-PD1 antibodies have demonstrated durable response and 54 unprecedented clinical benefit in a subset of patients across multiple types of solid tumors (1-6).”
BackgroundHaas, L., Elewaut, A., Gerard, C. L., Umkehrer, C., Leiendecker, L., Pedersen, M., Kręcioch, I., Hoffmann, D., Novatchkova, M., Kuttke, M., et al. (2021) · Nature Cancer · doi:10.1038/s43018-021-00221-9 · Cited by 196
Self-citationStudy and analysis of antitumor resistance mechanism of PD1/PD‐L1 immune checkpoint blocker
Wang, Z., & Wu, X. (2020) · Cancer Medicine · doi:10.1002/cam4.3410 · Cited by 205
Resistance mechanisms to immune checkpoint inhibitors: updated insights
Al-Saafeen, B. H., Ali, B. R., & Elkord, E. (2025) · Molecular Cancer · doi:10.1186/s12943-024-02212-7 · Cited by 226
“…upregulation of alternative immune check-point molecules is a potential target for immunotherapy combinations and the beneficial outcomes observed as a result of targeting multiple inhibitory immune check-points were demonstrated by undeniable number of pre-clinical and clinical studies [186–190].”
Ipilimumab and Gemcitabine for Advanced Pancreatic Cancer: A Phase Ib Study
Kamath, S. D., Kalyan, A., Kircher, S. M., Nimeiri, H. S., Fought, A. J., Benson, A. B., & Mulcahy, M. F. (2019) · The Oncologist · doi:10.1634/theoncologist.2019-0473 · Cited by 200
van den Berg, J. H., Heemskerk, B., van Rooij, N., Gomez-Eerland, R., Michels, S., van Zon, M., de Boer, R., Bakker, N. A. M., Jorritsma‐Smit, A., van Buuren, M. M., et al. (2020) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2020-000848 · Cited by 194
Self-citationJohnson, D. H., Zobniw, C. M., Trinh, V. A., Ma, J., Bassett, R. L., Abdel‐Wahab, N., Anderson, J. E., Davis, J. E., Joseph, J., Uemura, M. I., et al. (2018) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-018-0412-0 · Cited by 196
Tang, S., Tang, L., Mao, Y., Li, W., Chen, L., Zhang, Y., Guo, Y. Q., Liu, Q., Sun, Y. H., Xu, C., et al. (2020) · Cancer Research and Treatment · doi:10.4143/crt.2020.790 · Cited by 206
Ferrucci, P. F., Giacomo, A. M. D., Vecchio, M. D., Atkinson, V. G., Schmidt, H., Schachter, J., Queirolo, P., Long, G. V., Stephens, R., Svane, I. M., et al. (2020) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2020-001806 · Cited by 200
Self-citationMurakami, N., Mulvaney, P. M., Danesh, M. J., Abudayyeh, A., Diab, A. K., Abdel‐Wahab, N., Abdelrahim, M., Khairallah, P., Shirazian, S., Kukla, A., et al. (2020) · Kidney International · doi:10.1016/j.kint.2020.12.015 · Cited by 200
Self-citationO’Malley, D. M., Neffa, M., Monk, B. J., Melkadze, T., Huang, M., Kryzhanivska, A., Bulat, I., Meniawy, T. M., Bagameri, A., Wang, W., et al. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.21.02067 · Cited by 193
“The incidence of grade 3 or higher TRAEs (20%) is similar to previous trials that led to the approval of the nivolumab-ipilimumab combination in nongynecologic malignancies.(34,37-40)”
ResultNew therapeutic perspectives to manage refractory immune checkpoint-related toxicities
Martins, F., Sykiotis, G. P., Maillard, M. H., Fraga, M. C., Ribi, C., Küntzer, T., Michielin, O. A., Peters, S., Coukos, G., Spertini, F., et al. (2019) · The Lancet Oncology · doi:10.1016/s1470-2045(18)30828-3 · Cited by 190
The Role of the Estrogen Pathway in the Tumor Microenvironment
Rothenberger, N. J., Somasundaram, A., & Stabile, L. P. (2018) · International Journal of Molecular Sciences · doi:10.3390/ijms19020611 · Cited by 202
Regulation of Treg cells by cytokine signaling and co-stimulatory molecules
Zong, Y., Deng, K., & Chong, W. P. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1387975 · Cited by 202
Limeta, A., Ji, B., Levin, M., Gatto, F., & Nielsen, J. (2020) · JCI Insight · doi:10.1172/jci.insight.140940 · Cited by 185
Nakao, S., Arai, Y., Tasaki, M., YAMASHITA, M., Murakami, R., Kawase, T., Amino, N., Nakatake, M., Kurosaki, H., Mori, M., et al. (2020) · Science Translational Medicine · doi:10.1126/scitranslmed.aax7992 · Cited by 192
Immune checkpoint inhibitor‐induced Type 1 diabetes: a systematic review and meta‐analysis
Aktürk, H. K., Kahramangil, D., Sarwal, A., Hoffecker, L., Murad, M. H., & Michels, A. W. (2019) · Diabetic Medicine · doi:10.1111/dme.14050 · Cited by 195
Frank, M. J., Reagan, P. M., Bartlett, N. L., Gordon, L. I., Friedberg, J. W., Czerwinski, D. K., Long, S., Hoppe, R. T., Janssen, R. S., Candia, A. F., et al. (2018) · Cancer Discovery · doi:10.1158/2159-8290.cd-18-0743 · Cited by 190
Prediction and monitoring of relapse in stage III melanoma using circulating tumor DNA
Tan, L., Sandhu, S. K., Lee, R. J., Li, J., Callahan, J., Ftouni, S., Dhomen, N. S., Middlehurst, P., Wallace, A. J., Raleigh, J., et al. (2019) · Annals of Oncology · doi:10.1093/annonc/mdz048 · Cited by 196
Self-citationZhai, Y., Ye, X., Hu, F., Xu, J., Guo, X., Zhuang, Y., & He, J. (2019) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-019-0754-2 · Cited by 195
Metadata
- Authors
- Wolchok, J. D., Chiarion-Sileni, V., Gonzalez, R., Rutkowski, P., Grob, J.-J., Cowey, C. L., Lao, C. D., Wagstaff, J., Schadendorf, D., Ferrucci, P. F., Smylie, M., Dummer, R., Hill, A., Hogg, D., Haanen, J., Carlino, M. S., Bechter, O., Maio, M., Marquez-Rodas, I., Guidoboni, M., McArthur, G., Lebbé, C., Ascierto, P. A., Long, G. V., Cebon, J., Sosman, J., Postow, M. A., Callahan, M. K., Walker, D., Rollin, L., Bhore, R., Hodi, F. S., & Larkin, J.
- Affiliations
- University of Siena (IT)
- From the Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (J.D.W., M.A.P., M.K.C.); Oncology Institute of Veneto Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua (V.C.-S.), European Institute of Oncology, Milan (P.F.F.), Center for Immuno-Oncology, University Hospital of Siena, Istituto Toscano Tumori, Siena (M.M.), the Immunotherapy and Somatic Cell Therapy Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (M.G.),...
- ORCID
- Wolchok, Jedd D.
- Gonzalez, Rene
- Rutkowski, Piotr
- Grob, Jean-Jacques
- Cowey, C. Lance
- Wagstaff, John
- Schadendorf, Dirk
- Ferrucci, Pier F.
- Smylie, Michael
- Dummer, Reinhard
- Hogg, David
- Haanen, John
- Carlino, Matteo S.
- Bechter, Oliver
- Maio, Michele
- Guidoboni, Massimo
- McArthur, Grant
- Ascierto, Paolo A.
- Long, Georgina V.
- Cebon, Jonathan
- Sosman, Jeffrey
- Postow, Michael A.
- Callahan, Margaret K.
- Bhore, Rafia
- Hodi, F. Stephen
- Larkin, James
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-10-05
- Volume
- 377
- Issue
- 14
- Pages
- 1345-1356
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5706778
- OpenAlex
- W2753432434
- Semantic Scholar
- 23dbeed54cde655fb6a12697b02c9ff303515da7
- Cited by
- 5,357
- References
- 18
- Citations by year
- 2026: 159 · 2025: 282 · 2024: 569 · 2023: 705 · 2022: 746 · 2021: 947 · 2020: 900 · 2019: 578 · 2018: 428 · 2017: 37
- FWCI
- 234.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Use Siena air (University of Siena) (submittedVersion, other-oa)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Lirias (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Melanoma and MAPK Pathways
- Keywords
- advanced melanoma, nivolumab, ipilimumab, combination immunotherapy, immune checkpoint inhibitors, PD-1 inhibitors, CTLA-4 inhibitors, overall survival, progression-free survival, treatment-related adverse events, immune-related adverse events, PD-L1 expression, BRAF mutation, long-term follow-up
- MeSH terms
- Ipilimumab, Nivolumab, Adult, Aged, Antibodies, Monoclonal, Antineoplastic Combined Chemotherapy Protocols, Double-Blind Method, Humans, Melanoma, Middle Aged, Neoplasm Staging, Skin Neoplasms, Survival Rate, Disease-Free Survival, Kaplan-Meier Estimate
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