10-Years of First-Line Ipilimumab and Nivolumab in Advanced Melanoma: A Single Centre Experience

We conducted a single-centre retrospective study to evaluate the efficacy and safety of first-line ipilimumab and nivolumab in the management of advanced melanoma in patients treated at a single, tertiary centre. We included advanced melanoma patients treated with first-line ipilimumab and nivolumab at the Royal Marsden Hospital, London between 2013 and 2024. Patient outcomes and safety profile were assessed. 332 eligible patients were identified. 58% were male. Median age was 61 (IQR: 52-70) years. Median follow up was 59.9 (95% CI: 47.0-71.2) months. Median overall survival (OS) was 33.4 (95% CI: 26.9-51.4) months with 41% and 36% of patients being alive after 5 and 10 years. Median progression-free survival (PFS) was 8.6 (95% CI: 5.72-10.9) months and median melanoma-specific survival (MSS) was 46 (95% CI: 32-not reached) months. 3-year PFS correlated with a 10-year OS and MSS of 86% and 95% respectively. More advanced Eastern Cooperative Oncology Group performance status, raised lactate dehydrogenase and presence of brain metastases were negative prognostic factors. Any-grade immune-related adverse events (irAEs) were reported in 92.8% of patients, with 48.5% experiencing grade 3/4 toxicity. 70% of patients required systemic corticosteroids and 30% required secondary immunosuppression. While the occurrence of irAEs was associated with improved survival, higher peak corticosteroid dose impacted survival outcomes negatively. This study confirms the real-world efficacy of first-line ipilimumab and nivolumab in advanced melanoma patients, including those with adverse prognostic features. Immune-mediated toxicity remains a significant challenge and the results of this study support the development of steroid-sparing irAE management algorithms to optimise patient outcomes.