During a Targeted Oncology™ Case-Based Roundtable™ event, Hussein A. Tawbi, MD, PhD, asked several participants to share their experiences treating patients with metastatic melanoma with nivolumab plus relatlimab. This is the second of 2 articles based on this event.
What is your experience with nivolumab plus relatlimab-rmbw (Opdualag)? Have you used it in a clinical trial or in a real-world practice setting?
HUSSEIN TAWBI, MD, PHD: Nivolumab and relatlimab is now a fixed-dose combination that's FDA approved, based on RELATIVITY-047 [NCT03470922]. Half of you have used it as a standard of care, and the other half hasn't. Dr Ramadoss, tell us more about your experience.
UMASANKAR RAMADOSS, MD: I have a patient who had multiple lung metastases, and no brain metastases, and he still works full time. I thought he would be a perfect candidate. He has gotten 2 cycles so far, with no [significant] adverse events [AEs] so far. He's been happy. He did have some coughing, which has improved 2 or 3 weeks after the second cycle. He's due to come next week again for his treatment.
TAWBI: Has anyone else used nivolumab/relatlimab? What are your experiences so far?
HANI ALKHATIB, MD: I have 4 patients already on it. I like it more than ipilimumab/nivolumab and the 4 of them have done well, including a young woman aged 35 years with brain and liver metastases and lymph node disease who I have been treating for 3 or 4 years. The brain lesions [received] stereotactic body radiation therapy or whole brain radiation. She was BRAF positive so I treated her before with encorafenib [Braftovi] and binimetinib [Mektovi] and treated the brain metastases…. Also, she's been on nivolumab/relatlimab for close to 6 months now and her disease is in complete remission, cranial and extracranial.
TAWBI: Wonderful, that's fascinating. That's a great experience, thank you for sharing, because the data [for nivolumab/relatlimab] in the second line is a bit less impressive than the first line.1 Did that patient have any AEs with the combination?
ALKHATIB: No, she has done well with the oral treatments and the intravenous treatments. She's in complete remission…with no significant AEs, and the other 3 patients have not had any AEs from immunotherapy. They have done well with this combination compared with ipilimumab…. I used to use ipilimumab/nivolumab; there was a large amount of toxicity from ipilimumab so I have been trying to avoid it, although it's category 1, but once they approved [nivolumab plus] relatlimab I switched to this protocol as first-line treatment.
TAWBI: That's interesting. That's even better than my experiences. I do see some toxicity. For the half who haven't used nivolumab/relatlimab, is it an issue of access? Or is it not having the right patients?
MAGDALENA FLEJSIEROWICZ, MD: I think it's just not the right patient, in my case.
KURT DEMEL, MD: I tend not to see much melanoma, so I haven't used it yet. I haven't had the right patient.
TAWBI: Would anyone else like to share their experiences?
YAN JI, MD: I have treated probably 5 or 6 patients with this regimen. My experience is mixed. For the first 2, it was bad. One patient developed hypophysitis and hypotension, [plus] itching and fatigue, and we had to hospitalize him and start the hormone supplement. The second patient was worse; they got myasthenia gravis, so we had to immediately admit the patient. Luckily, that plateaued, and then for the next 4, the experience has been good, and I have not seen any grade 3 toxicity. [I have seen] grade 2 AEs; some patients had some gastrointestinal AEs. Fatigue is another common complaint. But so far, I have seen a partial response in all of the patients—that's one of the good things. There was even [a response in] a patient we only treated with a couple cycles and stopped because of grade 3 toxicity.
TAWBI: Thank you for sharing. Myasthenia gravis is always tough and completely unpredictable. Those are rough cases, but it’s great to hear.
1. Ascierto PA, Lipson EJ, Dummer R, et al. Nivolumab and relatlimab in patients with advanced melanoma that had progressed on anti-programmed death-1/programmed death ligand 1 therapy: results from the phase I/IIa RELATIVITY-020 trial. J Clin Oncol. 2023;41(15):2724-2735. doi:10.1200/JCO.22.02072