FDA Approves New Immunotherapy Combo for Metastatic Melanoma

M. Alexander Otto, MMS, PA

March 18, 2022

The FDA tonight approved a combination nivolumab/relatlimab-rmbw immune checkpoint inhibitor (Opdualag) for unresectable or metastatic melanoma in adults and children 12 years or older, according to the drug's manufacturer, Bristol-Myers Squibb. 

Approval was based on the company's RELATIVITY-047 trial, which found a median progression-free survival (PFS) of 10.1 months among 355 patients randomly assigned to the combination therapy compared with 4.6 months among 359 patients who received nivolumab alone (HR, 0.75; P = .0055).

In the combination therapy group, 18.9% of patients reported a grade 3/4 drug-related adverse event compared with 9.7% in the nivolumab group; 14.6% of patients in the combination group had drug-related adverse events leading to discontinuation vs 6.7% of those receiving monotherapy, the company noted in a press release.

Relatlimab is the company’s third immune checkpoint inhibitor to reach the US market, joining the PD-1 inhibitor nivolumab and the CTLA-4 blocker ipilimumab. Relatlimab targets lymphocyte-activation gene 3 (LAG-3), a cell-surface receptor found on activated CD4+ T cells.

Nivolumab plus ipilimumab is currently the standard of care for previously untreated metastatic or inoperable melanoma. Both combinations produce similar PFS, but the incidence of grade 3/4 adverse events is higher with ipilimumab, according to a January 6 editorial in the New England Journal of Medicine.

Musculoskeletal pain, fatigue, rash, pruritus, and diarrhea were the most common adverse reactions with combination nivolumab/relatlimab, occurring in 20% or more of RELATIVITY-047 trial participants.

Adrenal insufficiency, anemia, colitis, pneumonia, and myocardial infarction were the most frequent serious adverse reactions, but each occurred in less than 2% of patients. There were three fatal adverse events in the trial due to hemophagocytic lymphohistiocytosis, acute lung edema, and pneumonitis.

The approved dosage is 480 mg nivolumab and 160 mg relatlimab administered intravenously every 4 weeks.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape and is also an MIT Knight Science Journalism fellow. He can be reached at aotto@mdedge.com.

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