Which Immunotherapy Should be Used for Front-Line BRAF Wild-Type Patients? [Video]

The treatment options for Stage IV melanoma have evolved significantly over the years, with immunotherapy emerging as a promising approach.

In this video, Dr. Miles Andrews, BSc(Hons) BMBS(Hons) FRACP PhD, Medical Oncologist and Head of Immuno-oncology at The Alfred, and Senior Research Fellow at Monash University
Melbourne, Victoria, Australia, discusses the best immunotherapy option for front-line treatment of BRAF wild-type patients with Stage IV melanoma. Two options discussed are single-agent immunotherapy or combination immunotherapy using Checkmate 067.

Single-agent immunotherapy involves using drugs that stimulate the patient’s immune system to recognize and attack cancer cells. This approach has shown remarkable success in some cases, leading to long-term remission and improved survival rates. However, it may not be effective for all patients due to individual differences in immune response.

On the other hand, combination immunotherapy involves using multiple drugs that target different aspects of the immune system to enhance its anti-cancer activity. Checkmate 067 is a clinical trial that evaluated the efficacy of combining two immune checkpoint inhibitors – nivolumab and ipilimumab – in front-line treatment for advanced melanoma.

Dr. Andrews explains that both single-agent and combination immunotherapies have demonstrated significant benefits in treating Stage IV melanoma patients. However, choosing between them depends on several factors such as patient characteristics, tumor burden, and potential side effects.

For BRAF wild-type patients with high tumor burden or aggressive disease progression, combination immunotherapy may be more appropriate. The synergistic effect of combining nivolumab and ipilimumab has shown superior response rates and improved overall survival compared to single-agent immunotherapy in this patient population.

However, he emphasizes that combination immunotherapy is associated with a higher risk of immune-related adverse events (irAEs). These side effects can range from mild to severe and may affect various organs, requiring close monitoring and management. Therefore, when considering combination immunotherapy for patients, the patient’s needs should be carefully evaluated for their ability to tolerate potential side effects.