ABSTRACT We conducted a single‐centre retrospective study to evaluate the efficacy and safety of first‐line ipilimumab and nivolumab in the management of advanced melanoma in patients treated at a single, tertiary centre. We included advanced melanoma patients treated with first‐line ipilimumab and nivolumab at the Royal Marsden Hospital, London between 2013 and 2024. Patient outcomes and safety profile were assessed. 332 eligible patients were identified. 58% were male. Median age was 61 (IQR: 52–70) years. Median follow up was 59.9 (95% CI: 47.0–71.2) months. Median overall survival (OS) was 33.4 (95% CI: 26.9–51.4) months with 41% and 36% of patients being alive after 5 and 10 years. Median progression‐free survival (PFS) was 8.6 (95% CI: 5.72–10.9) months and median melanoma‐specific survival (MSS) was 46 (95% CI: 32‐not reached) months. 3‐year PFS correlated with a 10‐year OS and MSS of 86% and 95% respectively. More advanced Eastern Cooperative Oncology Group performance status, raised lactate dehydrogenase and presence of brain metastases were negative prognostic factors. Any‐grade immune‐related adverse events (irAEs) were reported in 92.8% of patients, with 48.5% experiencing grade 3/4 toxicity. 70% of patients required systemic corticosteroids and 30% required secondary immunosuppression. While the occurrence of irAEs was associated with improved survival, higher peak corticosteroid dose impacted survival outcomes negatively. This study confirms the real‐world efficacy of first‐line ipilimumab and nivolumab in advanced melanoma patients, including those with adverse prognostic features. Immune‐mediated toxicity remains a significant challenge and the results of this study support the development of steroid‐sparing irAE management algorithms to optimise patient outcomes.
Javaid et al. (Thu,) studied this question.