Dr. Long on Rationale for Nivolumab/Ipilimumab in Patients With Melanoma Who Have Brain Mets

Georgina V. Long, BSc, PhD, MBBS, FRACP, co-medical director of Melanoma Institute Australia (MIA), chair of Melanoma Medical Oncology and Translational Research at MIA and Royal North Shore Hospital, University of Sydney, discusses the rationale for the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) in patients with melanoma who have brain metastases.

Patients with melanoma brain metastases, approximately 20% to 25% of the overall population of patients with advanced disease, have a poor prognosis, says Long. Despite this, they are often excluded from clinical trials. This unmet need served as the basis for a phase II trial (NCT02374242), in which investigators evaluated the combination of nivolumab and ipilimumab versus nivolumab alone in patients with previously untreated melanoma and brain metastases, explains Long.

According to the design of the trial, patients were randomized to 1 of 2 cohorts: cohort A with the combination (n = 35), or cohort B with nivolumab alone (n = 25). Investigators included a third cohort for patients with brain metastases who had failed local therapy, had neurological symptoms, and/or had leptomeningeal disease (n = 16), says Long. However, responses to nivolumab monotherapy were modest in this cohort, concludes Long.