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Published on: February 8, 2018
Comparative efficacy and safety of immune checkpoint inhibitor-related therapies for advanced melanoma: a Bayesian
Xin Li1, Junpeng Wang2, Yun Yao1
1Department of Molecular Biology, College of Basic Medical Sciences, Norman Bethune Health Science Center, Jilin University, Changchun 130021, China.
Objectives:
We aimed to compare and rank the effects of 9 immune checkpoint inhibitor-related therapies for treating advanced melanoma.
Methods:
We searched Pubmed, Cochrane databases, Web of Science, and ClinicalTrials.gov for randomized controlled trials of the immune checkpoint inhibitor-related treatments for advanced melanoma. Analysis was done on a Bayesian framework.
Results:
Twelve trials including 5413 patients were identified. Ipilimumab plus nivolumab, nivolumab, and pembrolizumab were significantly more efficacious for progression-free survival (PFS) than ipilimumab (hazard ratio [HR], 0.38, 0.50, and 0.58, respectively), ipilimumab plus chemotherapy (0.45, 0.60, and 0.70, respectively), or ipilimumab plus sargramostim (0.44, 0.57, and 0.67, respectively). Ipilimumab plus gp100 was significantly less efficacious for PFS than the remaining eight immune checkpoint inhibitor-related strategies. Pembrolizumab was significantly more efficacious than ipilimumab and ipilimumab plus gp100 (HR, 0.66, and 0.64, respectively) in improving overall survival (OS). Nivolumab significantly improved OS over tremelimumab (HR, 0.48). Ipilimumab plus sargramostim was ranked the second most effective strategy in terms of OS and well tolerated. Nivolumab and pembrolizumab showed the best profile of acceptability, with significantly less high-grade adverse events than ipilimumab (odds ratio [OR], 0.49 and 0.50, respectively), tremelimumab (0.21 and 0.21, respectively), ipilimumab plus chemotherapy (0.13 and 0.13, respectively), or ipilimumab plus nivolumab (0.15 and 0.15, respectively).
Conclusions:
Nivolumab, pembrolizumab and ipilimumab plus sargramostim might be optimum treatments for advanced melanoma because they have the most favorable balance between benefits and acceptability. Ipilimumab plus nivolumab is the most effective in prolonging PFS, but is far more toxic than nivolumab and pembrolizumab.
Insights
Nivolumab, pembrolizumab, and ipilimumab plus sargramostim offer the best balance of benefits and safety for advanced melanoma patients. While ipilimumab plus nivolumab improves progression-free survival, it has higher toxicity.
Area of Science:
- Oncology
- Immunotherapy
- Melanoma Treatment
Background:
- Advanced melanoma presents a significant therapeutic challenge.
- Immune checkpoint inhibitors (ICIs) have revolutionized melanoma treatment.
- Comparing the efficacy and safety of various ICI-related therapies is crucial.
Purpose of the Study:
- To compare and rank the effectiveness of nine immune checkpoint inhibitor-related therapies for advanced melanoma.
- To evaluate the balance between therapeutic benefits and patient acceptability for each treatment strategy.
Main Methods:
- Systematic literature search of PubMed, Cochrane, Web of Science, and ClinicalTrials.gov for randomized controlled trials.
- Bayesian network meta-analysis framework to compare treatment efficacy and safety.
- Inclusion of 12 trials with 5413 patients in the analysis.
Main Results:
- Nivolumab, pembrolizumab, and ipilimumab plus sargramostim demonstrated a favorable benefit-risk profile.
- Ipilimumab plus nivolumab showed superior progression-free survival (PFS) but higher toxicity.
- Nivolumab and pembrolizumab exhibited the best safety profiles with significantly fewer adverse events.
Conclusions:
- Nivolumab, pembrolizumab, and ipilimumab plus sargramostim are potential optimal treatments for advanced melanoma.
- The choice of therapy should consider the balance between efficacy (PFS, OS) and tolerability.
- Ipilimumab plus nivolumab is highly effective for PFS but carries a significant toxicity burden.
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