ESMO: A 50% cure rate in melanoma? Long-term stats show Opdivo-Yervoy can do it: expert

melanoma
Bristol-Myers immunotherapies Opdivo and Yervoy help patients live longer when used on their own, but together helped half of patients with advanced melanoma—the cells pictured here—survive for five years or more. (National Cancer Institute)

BARCELONA—When Bristol-Myers Squibb’s Yervoy won its first approval in 2011, the immunotherapy was the first new melanoma treatment in years—and the first to actually help patients live longer. The company’s checkpoint inhibitor Opdivo had even better numbers when it made its 2016 debut.

Even better? Turning the two drugs into a one-two punch—and as new long-term data released Saturday show, that knockout can last for years.

More than half of advanced melanoma patients treated with Opdivo and Yervoy were still alive after five years, according to follow-up numbers from the Checkmate-067 study presented at the European Society for Medical Oncology Congress in Barcelona.

The 5-year analysis—the longest phase 3 followup for a checkpoint inhibitor combo—showed 52% of patients on the Opdivo-Yervoy pairing were still alive. Forty-four percent of patients treated with Opdivo alone were still living, and among Yervoy monotherapy patients, 26% had survived to the 5-year mark.

Perhaps just as surprising, the Opdivo-Yervoy combo—two immunotherapies paired together—continued to work even in patients who’d stopped taking it because of side effects, said lead author James Larkin of the Royal Marsden NHS Foundation Trust in London.

“One of the key points about immunotherapies is that you can re-educate the immune system even with a short duration of treatment,” Larkin said. “This is in contrast to other treatments like chemotherapy which require a full course to be effective.”

Opdivo and Yervoy together do carry a bigger risk of side effects than either drug alone, and more recent BMS studies—such as the Checkmate 227 study also presented here Saturday—have been pairing Opdivo with a lower Yervoy dose. But these Checkmate 067 followup numbers show quality of life was similar for patients on the Opdivo monotherapy and the combo.

Hand in hand with the overall survival advantage for Opdivo-plus-Yervoy are numbers showing some three-fourths of patients initially treated with the combo hadn’t moved on to a second round of treatment. Among the Yervoy monotherapy patients still living at the five-year mark, 45% had required follow-up treatment and 58% of Opdivo monotherapy patients did. 

The survival advantage held true for patients with BRAF mutations—even better, in fact. The study found 60% of BRAF-mutated patients were still alive after five years; on the mono therapy side, 46% of Opdivo patients and 30% of Yervoy patients were still living. But BRAF-targeted drugs have delivered some impressive survival stats as well, and so oncologists need to weigh the two approaches, said Teresa Amaral, M.D., of the Centre for Dermato-oncology, Eberhard Karls University in Germany.

“Ten years ago, the five-year survival for melanoma was around 5%,” Larkin said. “This treatment transforms the disease to one with an approximately 50% cure rate. The priority now is to find ways to cure the remaining 50%.”

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