Oops, you're using an old version of your browser so some of the features on this page may not be displaying properly.

MINIMAL Requirements: Google Chrome 24+Mozilla Firefox 20+Internet Explorer 11Opera 15–18Apple Safari 7SeaMonkey 2.15-2.23

Poster display

3145 - Single center experience on patients with advanced melanoma treated with short-term anti-CTLA4 directly followed by anti-PD-1


09 Oct 2016


Poster display


Elisa. A. Rozeman


Annals of Oncology (2016) 27 (6): 379-400. 10.1093/annonc/mdw379


E..A. Rozeman1, A. Meerveld-Eggink1, F. Lalezari2, J.V. van Thienen1, J.B.A.G. Haanen1, C.U. Blank1

Author affiliations

  • 1 Department Of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 2 Department Of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL


Abstract 3145


Combination of T-cell checkpoint blockade by anti-CTLA4 (ipilimumab, IPI) and anti-PD-1 (nivolumab, NIVO) is one of the most promising therapies in patients with late stage melanoma. It induces a superior objective response rate (ORR) (58%) as compared to single agent NIVO (44%) or IPI (19%) therapy (Checkmate 067 study). This superior efficacy is, however, associated with a high percentage of ≥ grade 3 adverse events (AEs)(55% versus 16% and 27%). The combination therapy is currently not available in the Netherlands, which prompted physicians to treat patients with short-term IPI directly followed by NIVO or pembrolizumab (PEM).


In this retrospective analysis, patients were included who were treated with short-term IPI q3wk (two courses day 0 and 21), directly followed by anti-PD-1 (starting at day 22 and onwards depending on the schedule (every 2 weeks for NIVO and 3 weeks for PEM)). Treatment related AEs data were collected from electronic patient dossiers and scored according to CTCAE 4.0 criteria. Response was evaluated using RECIST 1.1 for CT-scans and EORTC criteria for PET-scans.


Between May and December 2015, 40 patients with advanced melanoma were treated with IPI directly followed by anti-PD-1 (29/40 PEM, 11/40 NIVO). Baseline characteristics were: median age 54; male 55%; primary tumor site: skin 73%, mucosal 10%, unknown 17%; BRAFV600 mutation 58%; AJCC stage IV M1c 80%; brain metastases 20%; LDH >ULN 25%; prior systemic treatment 28%. Median follow-up (FU) so far is 31 weeks (range: 5-42 weeks) and an update will be presented. Treatment related grade ≥3 AEs occurred in 33% of patients; most prevalent were colitis (18%), increased ALT/AST (8%) and maculopapular rash (5%). In 6 patients (15%) treatment was permanently discontinued due to toxicity. ORR was 48% (95%CI: 32-64) and disease control rate was 75% (95%CI: 54-85). Ongoing responses were observed in 84% of responding patients.


Short-term IPI directly followed by NIVO/PEM seems to induce similar disease control as compared to concurrent IPI + NIVO, while grade 3/4 toxicity is lower. A randomized controlled clinical trial is in preparation to evaluate this alternative regimen.

Clinical trial identification

Legal entity responsible for the study

Netherlands Cancer Institute -Antoni van Leeuwenhoek hospital


Netherlands Cancer Institute -Antoni van Leeuwenhoek hospital


J.V. van Thienen: Advisory role: MSD and Bristol-Meyers-Squibb. J.B.A.G. Haanen: Research grants: MSD, Bristol-Myers-Squibb and GlaxoSmithKline. Advisory role: MSD Oncology, Pfizer, Bristol-Myers-Squibb, Novartis, Neon Therapeutics and Roche/Genentech. C. Blank: Research grant: Novartis. Advisory role: Novartis, Roche/Genentech, MSD, GlaxoSmithKline, Bristol-Myers-Squibb, Lilly and Pfizer. All other authors have declared no conflicts of interest.

This site uses cookies. Some of these cookies are essential, while others help us improve your experience by providing insights into how the site is being used.

For more detailed information on the cookies we use, please check our Privacy Policy.

Customise settings