Real world comparison of immune-related adverse events with nivolumab-relatlimab versus ipilimumab-nivolumab in patients with advanced cutaneous melanoma

Introduction Frontline therapy for patients with advanced cutaneous melanoma often includes immune checkpoint inhibitors (ICIs). Although these agents have increased response rates, many patients will experience immune-related adverse events (irAEs). The difference in safety profiles of the current combinations available are not well established. Therefore, this study aimed to compare the incidence of severe irAEs of patients receiving ipilimumab-nivolumab versus nivolumab-relatlimab in a real-world setting.Methods A retrospective chart review was conducted on all patients who underwent treatment with either combination ICI for advanced cutaneous melanoma.Results A total of 47 patients who received either one or more doses of either combination ICI were included for analysis. Of these patients, 37 (78.2%) had at least one irAE of any grade. The baseline characteristics among the patients who received nivolumab-relatlimab and those who received ipilimumab-nivolumab were not significantly different. The severity of the 73 irAEs that occurred ranged from grade 1 to grade 3, with 16 (21.9%) irAEs occurring in the nivolumab-relatlimab, 3 (18.8%) of which were grade 3-4. Meanwhile, those receiving ipilimumab-nivolumab developed 57 (78.1%) irAEs, with 14 (24.6%) being grade 3-4. This study's findings show that nivolumab-relatlimab had a lower incidence of developing severe irAEs in comparison to ipilimumab-nivolumab.Conclusions Treatment with nivolumab-relatlimab could be preferred as a combination ICI given the lower incidence of severe irAEs, delayed onset of irAEs, and lower rate of treatment discontinuation.