In an interview with Oncology Nursing News, Krista M. Rubin, MS, FNP-BC, RN, a nurse practitioner at the Center for Melanoma at the Mass General Cancer Center, discussed the implications of the recent U.S. Food and Drug Administration (FDA) approval of the bispecific antibody tebentafusp-tebn as well as the more widespread use of relatlimab in combination with nivolumab in patients with advanced melanoma.
Ms. Rubin explained that the combination of relatlimab and nivolumab is currently indicated for patients with unresectable metastatic melanoma after the phase II/III RELATIVITY-047 trial (ClinicalTrials.gov identifier NCT03470922) demonstrated that patients who received both agents saw improvements in progression-free survival vs those who received nivolumab alone. She noted that patients who receive this combination are generally frailer or do not have aggressive metastases. “[In] nivolumab [plus] relatlimab … response rates are somewhat lower, but … the risk of high-grade toxicity is also lower (approximately 19%),” Ms. Rubin highlighted. “This is a front-line choice for patients with limited disease and/or those who are asymptomatic or minimally symptomatic, whereas … nivolumab or pembrolizumab [monotherapy] is the least likely to cause high-grade toxicity (approximately 10%) but also has the lowest response rates.”
Ms. Rubin stated that tebentafusp has been indicated for patients with adult patients with unresectable or metastatic uveal melanoma who are human leukocyte antigen–A*02:01–positive. The FDA’s approval comes after the phase II IMCgp100-202 trial (NCT03070392) concluded that patients who received tebentafusp achieved superior overall survival rates after 1 year of follow-up vs patients who received investigators’ choice of therapy (pembrolizumab, ipilimumab, or dacarbazine). Ms. Rubin stressed that although tebentafusp is administered in the outpatient setting, patients are admitted overnight for observation because the agent can cause cytokine-release syndrome; however, the condition was well managed during the trial. “It’s a relatively predictable treatment; there is kind of a realm of what you can expect that you generally follow,” she suggested. Ms. Rubin expressed hope that the delivery of melanoma treatments will become more refined in the future.