15P - Efficacy of anti-CTLA-4 after progression on anti-PD1 therapy in advanced melanoma

Date 20 November 2015
Event ESMO Symposium on Immuno-Oncology 2015
Session Welcome reception and general Poster viewing
Topics Cancer Immunology and Immunotherapy
Melanoma and other Skin Tumours
Presenter Francisco Aya Moreno
Citation Annals of Oncology (2015) 26 (suppl_8): 5-14. 10.1093/annonc/mdv514
Authors F. Aya Moreno, A. Fernandez-Martinez, L. Gaba, I. Victoria, A.M. Arance Fernandez
  • Medical Oncology, Hospital Clinic y Provincial de Barcelona, 08036 - Barcelona/ES

Abstract

Aim

Nivolumab (nivo) and pembrolizumab (pembro) have demonstrated clinical benefit in advanced melanoma in untreated patients (pts) and after progression to ipilimumab (ipi). However, scarce evidence of efficacy and safety of ipi when administered after anti-PD1 therapy exists.

Methods

This is a retrospective, single-institution, descriptive analysis of 8 pts diagnosed with advanced melanoma treated with ipi 3mg/kg every 3 weeks for 4 doses after progression to nivo (3mg/kg every 2 weeks) or pembro (10 mg/kg every 2 or 3 weeks). Primary objectives are response by RECIST v1.1 criteria, and toxicity according to CTCAE v4.

Results

Between October 2013 and February 2015, a total of eight pts diagnosed with metastatic melanoma (all of them stage IV-M1c) were treated with ipi following progression on anti-PD1 therapy. Six pts (75%) had a high LDH, 1 pt brain metastasis and 1 with a BRAF mutation. Two (25%) and six pts (75%) received nivo and pembro respectively. Median time to the start of anti-PD1 antibodies was 2.5 months. Two pts (25%) experienced a partial response and 5 pts (62.5%), progressive disease. Half of the pts presented grade 3 adverse events that led to ipi cessation: hepatotoxicity (3/8), diarrhea (1/8) and rash (1/8). No grade 4 toxicity events were reported. Median progression-free survival was 3.1 months (95% CI 2.62-3.65) and 50% of pts were alive at the time of this analysis, with a median follow-up of 14 months.

Conclusions

Our experience with ipilimumab administered after progression to anti-PD1 therapy suggests a higher objective response rate and more frequent toxicity compared to published data of ipi for patients treated with ipi prior to anti-PD1 antibodies.

Clinical trial identification

Disclosure

A.M. Arance Fernandez: Travel grants and honoraria for lectures from Roche, Novartis, BMS, MSD. All other authors have declared no conflicts of interest.