Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma

By H. Tawbi, D. Schadendorf, E. Lipson, P. Ascierto, L. Matamala, E. Castillo Gutiérrez, P. Rutkowski, H. Gogas, C. Lao, J. J. de Menezes and 12 more. New England Journal of Medicine, 2022

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BACKGROUND Lymphocyte-activation gene 3 (LAG-3) and programmed death 1 (PD-1) are distinct inhibitory immune checkpoints that contribute to T-cell exhaustion. The combination of relatlimab, a LAG-3–blocking antibody, and nivolumab, a PD-1–blocking antibody, has been shown to be safe and to have antitumor activity in patients with previously treated melanoma, but the safety and activity in patients with previously untreated melanoma need investigation. METHODS In this phase 2–3, global, double-blind, randomized trial, we evaluated relatlimab and nivolumab as a fixed-dose combination as compared with nivolumab alone when administered intravenously every 4 weeks to patients with previously untreated metastatic or unresectable melanoma. The primary end point was progression-free survival as assessed by blinded independent central review. RESULTS The median progression-free survival was 10.1 months (95% confidence interval [CI], 6.4 to 15.7) with relatlimab–nivolumab as compared with 4.6 months (95% CI, 3.4 to 5.6) with nivolumab (hazard ratio for progression or death, 0.75 [95% CI, 0.62 to 0.92]; P = 0.006 by the log-rank test). Progression-free survival at 12 months was 47.7% (95% CI, 41.8 to 53.2) with relatlimab–nivolumab as compared with 36.0% (95% CI, 30.5 to 41.6) with nivolumab. Progression-free survival across key subgroups favored relatlimab–nivolumab over nivolumab. Grade 3 or 4 treatment-related adverse events occurred in 18.9% of patients in the relatlimab–nivolumab group and in 9.7% of patients in the nivolumab group. CONCLUSIONS The inhibition of two immune checkpoints, LAG-3 and PD-1, provided a greater benefit with regard to progression-free survival than inhibition of PD-1 alone in patients with previously untreated metastatic or unresectable melanoma. Relatlimab and nivolumab in combination showed no new safety signals. (Funded by Bristol Myers Squibb; RELATIVITY-047 ClinicalTrials.gov number, NCT03470922.)

Subfields: Molecular Biology, Oncology

View Paper: https://www.semanticscholar.org/paper/5ae2ea607c7e18b3c259214fbd3286f6f5828b0a

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Citations in the corpus

• Regulatory mechanisms of PD-1/PD-L1 in cancers (2024, background): “In untreated metastatic or inoperable melanoma patients, combination treatment of Relatlimab (an anti-LAG-3 monoclonal antibody) with nivolumab demonstrates anti-tumor activity, significantly improving patients’ progression-free survival [376].”
• Impact of T Cell Exhaustion and Stroma Senescence on Tumor Cell Biology and Clinical Outcome of Head and Neck Squamous Cell Carcinomas (2024, unknown): “In melanoma, the dual LAG-3 and PD-1 inhibitor Opdualag was already approved by the FDA for treating unresectable or metastatic disease in adults and children [39,40].”