Sunday Melanoma Session at ECC2015- Nivo then Ipi versus Ipi then Nivo in Stage 4 Melanoma

Update on CHECKMATE 064- Hodi

Phase 2 , Nivo post Ipi vs Ipi post Nivo in Melanoma

140 patients

Ipi 3 mg
Nivo 3 mg

1 prior therapy allowed but no Immuno.



Disease progression more in Ipi first

More side effects on Nivo first

Immune- related side effects
Similar to direct combo

50 vs 31% Hepatitis Nivo/ Ipi vs Ipi/ Nivo


ORR 41 vs 20 % confirmed ORR 

TUMOUR BURDEN REDUCES FASTER on Nivo first

So- conclusion : Nivo then Ipi higher response rate than Ipi then Nivo but more side effects, similar to what one sees when Ipi and Nivo are giving at the same time.

Caroline Robert commented- surprising as currently one thought that Ipi recruits  T-cells that are then activated by PD1.
Also good as it could allow to start with PD1 and only add Ipi when needed, avoiding to limit side effects

Ipi plus Nivo better Nivo/Ipi better than Ipi/ Nivo

To be tested 
Intra-tumoral injection of Ipi plus Pd1