Gary K. Schwartz, MD
©Columbia

Gary K. Schwartz, MD, Chief of Hematology/Oncology and Deputy Director of the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Medical Center, New York, is not sold on using the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for all patients with advanced melanoma on the basis of this study. “The difference in 2-year survival between 64% with the combination and 59% with nivolumab is not significant. We have to think about costs and toxicity,” he said.

“We were all waiting with bated breath for the results of this study. We hoped that these data would give a signal that all patients should get the combination. I’m not convinced that the small survival benefit supports use of the combination for all advanced melanoma patients. My review of the data raises questions about making a blanket statement like that,” he continued.

Patient Subset?

“There may be a subset of patients based on [programmed cell death ligand 1] status, melanoma subtype, and age that can benefit from the combination. We need to review the data from this study in greater depth but not embrace the combination now. This is not a black-and-white decision but should be considered on a patient-by-patient basis,” Dr. Schwartz said.

“Nivolumab/ipilimumab is the best combination so far, but not every patient needs this. Why incur toxicity, such as diarrhea and endocrinopathies, which are not reversible, if you can get a similar benefit from nivolumab alone? Hopefully other combinations will be identified that are not associated with increased toxicity,” he said.

“At the end of the day, the gold-standard question is: Does the patient live longer?” he concluded. ■

Disclosure: Dr. Schwartz reported no potential conflicts of interest.