Combination therapy with nivolumab and vaccine for malignant melanoma
Weber et al examined the effect of nivolumab with or without a peptide vaccine for malignant melanoma.34 Ninety patients with stage III or IV advanced malignant melanoma were enrolled in this study. Objective response rate for nivolumab with or without vaccine was 25%. Objective response rate in PD-L1 tumor-positive group was 67% and that in PD-L1 tumor-negative group was 19%. The effect of combination with vaccine was not fully elucidated in this study.
Durable effect of nivolumab for malignant melanoma
Topalian et al studied the durable effect of nivolumab for malignant melanoma.35 One hundred and seven patients with malignant melanoma were enrolled in this study. Median overall survival was 16.8 months. Objective response rate was 31%.
In total, there were adverse events in 90 (84.1%) out of 107 patients: fatigue, pyrexia, pain, rash, pruritus, vitiligo, acneiform dermatitis, photosensitivity reaction, diarrhea, nausea, abdominal pain, dry mouth, vomiting, decreased appetite, hypothyroidism, and infusion-related reaction.
Comparison of the effect of nivolumab for malignant melanoma with other chemotherapies
Recent studies compared the effects and adverse events of nivolumab and other chemotherapies.36,37
The effect of nivolumab was compared with that of dacarbazine for malignant melanoma patients without BRAF mutation.36 Objective response rate for nivolumab-treated patients was 40.0%, while that for dacarbazine-treated patients was 13.9%. The rate of any adverse events in nivolumab-treated patients was 74.3%, whereas that for dacarbazine-treated patients was 75.6%.
Weber et al compared nivolumab with other chemotherapies, dacarbazine or paclitaxel with carboplatin, in patients unresponsive to anti-CTLA-4 treatment.37 Objective response rate for nivolumab was 31% and that for dacarbazine or paclitaxel with carboplatin was 10.7%.
Therefore, nivolumab has been well demonstrated to show better response for malignant melanoma than the existent chemotherapy, dacarbazine.
There are a lot of patients with advanced melanoma who are resistant to conventional chemotherapies with an alkylating agent, dacarbazine, and IFN-α. Recent studies have revealed that nivolumab with or without ipilimumab or vaccines can become an alternative therapy for those patients. Moreover, recent papers showed nivolumab treatment showed superior prognostic outcome than that of dacarbazine for advanced malignant melanoma. Based upon the findings mentioned above, nivolumab may be a well tolerable and durable therapy for an advanced melanoma.