Response to ipi or ipi/nivo after failing anti-PD1 as single agent in Stage IV melanoma

As their intro paragraph notes below....we know that anti-PD1 alone or combined with ipi does better than ipi alone. We know the response rate to ipi is about 15-20%.  We know that response rates to either anti-PD1 product (Nivo/Opdivo or Pembro/Keytruda) are about 40%.  We know that the ipi/nivo combo response rate is about 50% or a little better.  Here...though...they looked at folks who had failed anti-PD1 as a single agent and tried treating them with either ipi alone or the ipi/nivo combo....

Ipilimumab alone or in combination with nivolumab after progression on anti-PD-1 therapy in advanced melanoma. Zimmer, Apuri, Eroglu, ...Sondak, et al. Eur J Cancer. 2017 Feb 16.

The anti-programmed cell death-1 (PD-1) inhibitors pembrolizumab and nivolumab alone or in combination with ipilimumab have shown improved objective response rates and progression-free survival compared to ipilimumab only in advanced melanoma patients. Anti-PD-1 therapy demonstrated nearly equal clinical efficacy in patients who had progressed after ipilimumab or were treatment-naïve. However, only limited evidence exists regarding the efficacy of ipilimumab alone or in combination with nivolumab after treatment failure to anti-PD-therapy.

A multicenter retrospective study in advanced melanoma patients who were treated with nivolumab (1 or 3 mg/kg) and ipilimumab (1 mg or 3 mg/kg) or ipilimumab (3 mg/kg) alone after treatment failure to anti-PD-1 therapy was performed. Patient, tumour, pre- and post-treatment characteristics were analysed.

In total, 47 patients were treated with ipilimumab (ipi-group) and 37 patients with ipilimumab and nivolumab (combination-group) after treatment failure to anti-PD-1 therapy. Overall response rates for the ipi- and the combination-group were 16% and 21%, respectively. Disease control rate was 42% for the ipi-group and 33% for the combination-group. One-year overall survival rates for the ipi- and the combination-group were 54% and 55%, respectively.


Ipilimumab should be considered as a viable treatment option for patients with failure to prior anti-PD-1 therapy, including those with progressive disease as best response to prior anti-PD-1. In contrast, the combination of ipilimumab and nivolumab appears significantly less effective in this setting compared to treatment-naïve patients.

Sooo....while response rates were not as great as they are for the treatment naive patients.... a 21% response rate to the ipi/nivo combo can still be attained for those who have failed anti-PD1 as a single agent.

I wish you well.  - c