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nivolumab alone (n=316) vs. ipilimumab alone (n=315)
randomized controlled trial
nivolumab
nivolumab at a dose of 3 mg per kilogram every 2 weeks (plus ipilimumab-matched placebo)
ipilimumab
ipilimumab at a dose of 3 mg per kilogram every 3 weeks for four doses (plus nivolumab-matched placebo)
mML - L1 - all population
Other eligibility criteria included known BRAF V600 mutation status
double-blind
137 cancer centres in 21 countries
P3/ two sided test procedure without interim analysis (but OS prolonged) (efficacy endpoints were based on the intent-to-treat population and formal co-primary endpoint analyses were conducted at two different prespecified time points (separately for progression-free survival and overall survival) per the study protocol, as described previously)3 arms // repartition : OS 0.02/ARM (N vs I, NI vs I), PFS 0.005/ARM (N vs I, NI vs I), and hierarchical testing procedure for ORR with PFS results (N vs I, NI vs I)
Nivolumab alone or combined with ipilimumab improved progression-free survival (no threshold), as compared with ipilimumab, among previously untreated patients with metastatic melanoma
nivolumab followed by ipilimumab (n=68) vs. ipilimumab followed by nivolumab (n=70)
randomized controlled trial
nivolumab followed by ipilimumab
nivolumab 3 mg/kg as a 60-min intravenous infusion every 2 weeks for up to six doses, followed by a planned switch to ipilimumab 3 mg/kg as a 90-min intravenous infusion every 3 weeks for up to four doses
ipilimumab followed by nivolumab
ipilimumab 3 mg/kg as a 90-min intravenous infusion every 3 weeks for up to four doses followed by a planned switch to nivolumab 3 mg/kg as a 60-min intravenous infusion every 2 weeks for up to six doses (reciprocal planned switch sequence)
time interval between drug sequences was 2 weeks for nivolumab followed by ipilimumab whereas it was 3 weeks for ipilimumab followed by nivolumab patient with clinical benefit were eligible to enter the continuation period and receive nivolumab 3 mg/kg every 2 weeks for up to 2 years
mML - L1 - all population
Patients with active brain metastases were excluded
open label
nine sites in the USA
P2/ No statistical hypothesis testing, sequentiel N=>I vs I=>N No statistical hypothesis testing was planned (PE = safety)
No statistical hypothesis testing was planned to assess differences between groups because the primary endpoint was safety
nivolumab plus ipilimumab (n=95) vs. ipilimumab alone (n=47)
randomized controlled trial
nivolumab and ipilimumab
nivolumab (1 mg per kilogram) and ipilimumab (3 mg per kilogram of body weight) combined once every 3 weeks for four doses followed by nivolumab (3 mg per kilogram) every 2 weeks until the occurrence of disease progression or unacceptable toxic effects
ipilimumab
ipilimumab (3 mg per kilogram of body weight) combined once every 3 weeks, nivolumab was replaced with matched placebo during both the combination and maintenance portions of the trial.
After the fourth dose of both agents, ipilimumab was discontinued, and thereafter (maintenance phase), nivolumab was administered as a single agent at a dose of 3 mg per kilogram over a period of 60 minutes, once every 2 weeks.
mML - L1 - all population
Other inclusion criteria included a known BRAF V600 mutation status and the availability for immunohistochemical assessment of PD-1 ligand (PD-L1) expression.
double-blind
United States and France
P2/ two sided test procedure without interim analysis. The primary end point was the rate of investigator-assessed, confirmed objective response among patients with BRAF V600 wild-type tumors. In order to preserve an experiment-wide type I error rate of 5%, a hierarchical testing approach was applied to key secondary end points safety in all randomized population (BRAF mutant and wild type). A hierarchical testing approach was applied to key secondary end points : ORR WT then ORR ITT then PFS WT then PFS ITTNo statistical analysis planned for BRAF mutant population
The objective-response rate and the progression-free survival among patients with advanced melanoma who had not previously received treatment were significantly greater with nivolumab combined with ipilimumab than with ipilimumab monotherapy. (in BRAFwild and all population)
nivolumab plus ipilimumab (n=314) vs. ipilimumab alone (n=315)
randomized controlled trial
nivolumab plus ipilimumab
nivolumab at a dose of 1 mg per kilogram of body weight every 3 weeks plus ipilimumab at adose of 3 mg per kilogram every 3 weeks for four doses, followed by nivolumab at a dose of3 mg per kilogram every 2 weeks
ipilimumab
ipilimumab at a dose of 3 mg per kilogram every 3 weeks for four doses (plus nivolumab-matched placebo).
Treatment was continued until disease progression, the occurrence of unacceptable toxicevents, or withdrawal of consent.
mML - L1 - all population
Adults, with known BRAF V600 mutation status,
double blind
137 cancer centres in 21 countries
P3/ two sided test procedure without interim analysis (but OS prolonged) (efficacy endpoints were based on the intent-to-treat population and formal co-primary endpoint analyses were conducted at two different prespecified time points (separately for progression-free survival and overall survival) per the study protocol, as described previously) 3 arms // repartition : OS 0.02/ARM (N vs I, NI vs I), PFS 0.005/ARM (N vs I, NI vs I), and hierarchical testing procedure for ORR with PFS results (N vs I, NI vs I)
Nivolumab alone or combined with ipilimumab improved progression-free survival (no threshold), as compared with ipilimumab, among previously untreated patients with metastatic melanoma
nivolumab plus ipilimumab (n=314) vs. nivolumab alone (n=316)
randomized controlled trial
nivolumab plus ipilimumab
nivolumab at a dose of 1 mg per kilogram of body weight every 3 weeks plus ipilimumab at adose of 3 mg per kilogram every 3 weeks for four doses, followed by nivolumab at a dose of3 mg per kilogram every 2 weeks
nivolumab
nivolumab at a dose of 3 mg per kilogram every 2 weeks (plus ipilimumab-matched placebo);
Treatment was continued until disease progression, the occurrence of unacceptable toxicevents, or withdrawal of consent.
mML - L1 - all population
Adults, with known BRAF V600 mutation status
double blind
137 cancer centres in 21 countries
P3/ two sided test procedure without interim analysis (but OS prolonged) (efficacy endpoints were based on the intent-to-treat population and formal co-primary endpoint analyses were conducted at two different prespecified time points (separately for progression-free survival and overall survival) per the study protocol, as described previously) 3 arms: hierarchical testing procedure and repartition : OS 0.02/ARM (N vs I, NI vs I), PFS 0.005/ARM (N vs I, NI vs I), ORR (N vs I, NI vs I) => exploratory for NI vs N
Nivolumab alone or combined with ipilimumab improved progression-free survival (no threshold), as compared with ipilimumab, among previously untreated patients with metastatic melanoma
relatlimab plus nivolumab (n=-9) vs. nivolumab alone (n=-9)
randomized controlled trial
relatlimab plus nivolumab
single fixed-dose intravenous (IV) infusion of 160 mg of relatlimab plus 480 in a fixed-dose coombination or 480 mg of IV nivolumab every 4 weeks.
nivolumab
480 mg of IV nivolumab every 4 weeks.
mML - L1 - all population
double blind
at 111 sites in North America, Central America, South America, Europe, Australia, and New Zealand
P2-3 /
tremelimumab (n=328) vs. Standard of Care (SoC) (n=327)
randomized controlled trial
tremelimumab
tremelimumab at 15 mg/kg once every 90 days for up to four cycles.
physician's choice of standard-of-care chemotherapy (temozolomide or dacarbazine)
either single-agent DTIC (1,000 mg/m2) IV on day 1 of a 21-day cycle or single-agent temozolomide (200 mg/m2) orally on days 1 to 5 of a 28-day cycle, up to 12 cycles. (64.5% dacarbazine and 33.0% temolozomide)
No dose reductions were permitted
mML - L1 - all population
Eligible patients had an Eastern Cooperative Oncology Group performance status of 0 or 1
open label
114 sites in 24 countries
P3/ two sided test procedure with two interim analysis. Repartition alpha with interim analysis (no IC for HR => CALCUL p value)
This study failed to demonstrate a statistically significant survival advantage of treatment with tremelimumab over standard-of-care chemotherapy in first-line treatment of patients with metastatic melanoma
atezolizumab plus SoC (n=256) vs. placebo plus SoC (n=258)
randomized controlled trial
atezolizumab plus cobimetinib plus vemurafenib
intravenous atezolizumab 840 mg (day 1 and 15) and twice daily oral vemurafenib 960 mg for 21 days plus oncedaily oral cobimetinib 60 mg followed by either twice daily vemurafenib 720 mg in the atezolizumab group or 960 mg for 7 days in the control group. THEN in cycle 2 twice daily vemurafenib 720 mg, and once daily cobimetinib 60 mg (21 days on–7 days off)
placebo plus cobimetinib plus vemurafenib
intravenous placebo (day 1 and 15) and twice daily oral vemurafenib 960 mg for 21 days plus oncedaily oral cobimetinib 60 mg followed by either twice daily vemurafenib 720 mg in the atezolizumab group or 960 mg for 7 days in the control group. THEN in cycle 2 twice daily vemurafenib 720 mg, and once daily cobimetinib 60 mg (21 days on–7 days off)
Patients in the control arm are not eligible for crossover to the treatment arm at diseaseprogression.
mML - L1 - BRAF mutant
Patients with untreated or actively progressing brain metastases, active malignancy other than melanoma, or history of serious autoimmune disease were excluded.
double-blind
112 institutes in 20 countries
P3/two sided and No interim analysis for primary EP. Hierarchical testing procedure (PFS then OS)
The addition of atezolizumab to targeted therapy with vemurafenib and cobimetinib was safe and tolerable and significantly increased progression-free survival in patients with BRAF
nivolumab plus ipilimumab (n=23) vs. ipilimumab alone (n=10)
randomized controlled trial
nivolumab and ipilimumab
nivolumab (1 mg per kilogram) and ipilimumab (3 mg per kilogram of body weight) combined once every 3 weeks for four doses followed by nivolumab (3 mg per kilogram) every 2 weeks until the occurrence of disease progression or unacceptable toxic effects
ipilimumab
ipilimumab (3 mg per kilogram of body weight) combined once every 3 weeks, nivolumab was replaced with matched placebo during both the combination and maintenance portions of the trial.
After the fourth dose of both agents, ipilimumab was discontinued, and thereafter (maintenance phase), nivolumab was administered as a single agent at a dose of 3 mg per kilogram over a period of 60 minutes, once every 2 weeks.
mML - L1 - BRAF mutant
Other inclusion criteria included a known BRAF V600 mutation status and the availability for immunohistochemical assessment of PD-1 ligand (PD-L1) expression
double-blind
United States and France
P2/ two sided test procedure without interim analysis. The primary end point was the rate of investigator-assessed, confirmed objective response among patients with BRAF V600 wild-type tumors. In order to preserve an experiment-wide type I error rate of 5%, a hierarchical testing approach was applied to key secondary end points. a hierarchical testing approach was applied to key secondary end points : ORR WT then ORR ITT then PFS WT then PFS ITTNo statistical analysis planned for BRAF mutant population
The objective-response rate and the progression-free survival among patients with advanced melanoma who had not previously received treatment were significantly greater with nivolumab combined with ipilimumab than with ipilimumab monotherapy.
atezolizumab plus cometinib (n=222) vs. pembrolizumab alone (n=224)
randomized controlled trial
cometinib plus atezolizumab
cobimetinib (60 mg once daily, days 1-21) plus intravenous atezolizumab (840 mg, days 1 plus 15) in 28-day cycles
pembrolizumab
intravenous pembrolizumab (200 mg every 3 weeks)
Dose reductions for atezolizumab or pembrolizumab were not permitted.
mML - L1 - BRAF wild
open label
multicenter
P3/ two sided and no interim analysis. Hierarchical testing procedure (PFS(IRC) then OS then ORR)
Cobimetinib plus atezolizumab did not improve PFS compared with pembrolizumab monotherapy in patients with BRAF mutation
nivolumab alone (n=210) vs. dacarbazine (n=208)
randomized controlled trial
nivolumab
Nivolumab at a dose of 3 mg per kilogram of body weight every 2 weeks, plus a dacarbazine-matched placebo every 3 weeks
dacarbazine
1000 mg of dacarbazine per square meter of body-surface area every 3 weeks, plus a nivolumab-matched placebo every 2 weeks.
Treatment continued until there was disease progression, as assessed by the investigator, or an unacceptable level of toxic effects. As a result, the monitoring committee recommended that the study be unblinded and amended to allow patients enrolled in the dacarbazine group to receive nivolumab.
mML - L1 - BRAF wild
exclusion criteria were active brain metastases, ans patients who had received adjuvant therapy previously were not excluded.
double-blind
Europe, Israel, Australia, Canada, and South America
P3/ two sided test procedure with interim analysis. Hierarchy OS then PFS then ORR
Nivolumab was associated with significant improvements in overall survival and progression-free survival, as compared with dacarbazine, among previously untreated patients who had metastatic melanoma without a BRAF mutation
nivolumab plus ipilimumab (n=72) vs. ipilimumab alone (n=37)
randomized controlled trial
nivolumab and ipilimumab
nivolumab (1 mg per kilogram) and ipilimumab (3 mg per kilogram of body weight) combined once every 3 weeks for four doses followed by nivolumab (3 mg per kilogram) every 2 weeks until the occurrence of disease progression or unacceptable toxic effects
ipilimumab
ipilimumab (3 mg per kilogram of body weight) combined once every 3 weeks, nivolumab was replaced with matched placebo during both the combination and maintenance portions of the trial.
After the fourth dose of both agents, ipilimumab was discontinued, and thereafter (maintenance phase), nivolumab was administered as a single agent at a dose of 3 mg per kilogram over a period of 60 minutes, once every 2 weeks.
mML - L1 - BRAF wild
Other inclusion criteria included a known BRAF V600 mutation status, and the availability for immunohistochemical assessment of PD-1 ligand (PD-L1) expression.
double-blind
United States and France
P2/ two sided test procedure without interim analysis. The primary end point was the rate of investigator-assessed, confirmed objective response among patients with BRAF V600 wild-type tumors. In order to preserve an experiment-wide type I error rate of 5%, a hierarchical testing approach was applied to key secondary end points. A hierarchical testing approach was applied to key secondary end points : ORR WT then ORR ITT then PFS WT then PFS ITTNo statistical analysis planned for BRAF mutant population
The objective-response rate and the progression-free survival among patients with advanced melanoma who had not previously received treatment were significantly greater with nivolumab combined with ipilimumab than with ipilimumab monotherapy. (in BRAFwild and all population)
Ipilimumab (10 mg/kg) (n=365) vs. ipilimumab alone (n=362)
randomized controlled trial
ipilimumab 10 mg
10 mg/kg ipilimumab was administered by intravenous infusion for 90 min every 3 weeks for four doses. Treatment was continued for a maximum of four doses
Ipilimumab 3 mg
3 mg/kg dose groups, ipilimumab was administered by intravenous infusion for 90 min every 3 weeks for four doses. Treatment was continued for a maximum of four doses
mML - L2 - all population
with an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1,
double blind
87 centres in 21 countries worldwide
P3/ two sided test procedure with one interim analysis / hierarchy : OS then PFS, ORR, DCR
In patients with advanced melanoma, ipilimumab 10 mg/kg resulted in significantly longer overall survival than did ipilimumab 3 mg/kg
Ipilimumab (10 mg/kg) (n=40) vs. ipilimumab alone (n=42)
randomized controlled trial
ipilimumab
10 mg/kg ipilimumab every 3 weeks (Q3W) × 4 induction doses
ipilimumab
3 mg/kg ipilimumab every 3 weeks (Q3W) × 4 induction doses
At Week 24 (W24), eligible patients could receive ipilimumab maintenance treatment every 12 weeks (Q12W) or enter a companion study for follow-up and/or extended therapy
mML - L2 - all population
24.4% pretreated with adjuvant and 65.9 pretreated for metastatic disease
double blind
14 sites in 7 European, North American, and South American countries
P2/ no alpha no interim analysis/ objectives did not estimate clinical benefits
PILOT STUDY : objectives did not estimate clinical benefits
ipilimumab alone (n=137) vs. gp100 (n=136)
randomized controlled trial
ipilimumab
ipilimumab, at a dose of 3 mg per kilogram of body weight administered once every 3 weeks for four treatments.
gp100
a gp100:209- 217(210M) peptide, 1 mg injected in the right anterior thigh, and a gp100:280-288(288V) peptide, 1 mg injected in the left anterior thigh administered once every 3 weeks for four treatments.
all administered once every 3 weeks for four treatments.
mML - L2 - all population
therapeutic regimen containing one or more of the following: dacarbazine, temozolomide, fotemustine, carboplatin, or interleukin-2.
double blind
25 centers in 13 coun- tries in North America, South America, Europe, and Africa
P3/ two sided test procedure without interim analysis. Hierarchy : OS ipi gp100 vs gp100 alone than OS ipi alone vs gp100 alone
Ipilimumab, with or without a gp100 peptide vaccine, as compared with gp100 alone, improved overall survival in patients with previously treated metastatic melanoma.
ipilimumab plus gp100 (n=403) vs. gp100 (n=136)
randomized controlled trial
ipilimumab plus a gp100 peptide vaccine
ipilimumab, at a dose of 3 mg per kilogram of body weight, plus a gp100 peptide vaccine
gp100
gp100:209- 217(210M) peptide, 1 mg injected in the right anterior thigh, and a gp100:280-288(288V) pep- tide, 1 mg injected in the left anterior thigh.
all administered once every 3 weeks for four treatments.
mML - L2 - all population
therapeutic regimen containing one or more of the following: dacarbazine, temozolomide, fotemus- tine, carboplatin, or interleukin-2.
double blind
25 centers in 13 countries in North America, South America, Europe, and Africa
P3/ two sided test procedure without interim analysis. hierarchy : OS ipi gp100 vs gp100 alone than OS ipi alone vs gp100 alone
Ipilimumab, with or without a gp100 peptide vaccine, as compared with gp100 alone, improved overall survival in patients with previously treated metastatic melanoma.
ipilimumab plus gp100 (n=403) vs. ipilimumab alone (n=137)
randomized controlled trial
ipilimumab plus gp100
ipilimumab, at a dose of 3 mg per kilogram of body weight plus gp100:209- 217(210M) peptide, 1 mg injected in the right anterior thigh, and a gp100:280-288(288V) pep- tide, 1 mg injected in the left anterior thigh.
Ipilimumab
ipilimumab, at a dose of 3 mg per kilogram of body weight
all administered once every 3 weeks for four treatments.
mML - L2 - all population
therapeutic regimen containing one or more of the following: dacarbazine, temozolomide, fotemus- tine, carboplatin, or interleukin-2.
double blind
25 centers in 13 coun- tries in North America, South America, Europe, and Africa
P3/ two sided test procedure without interim analysis. Hierarchy : OS ipi gp100 vs gp100 alone than OS ipi alone vs gp100 alone
Ipilimumab, with or without a gp100 peptide vaccine, as compared with gp100 alone, improved overall survival in patients with previously treated metastatic melanoma.
ipilimumab plus SoC (n=250) vs. placebo plus SoC (n=252)
randomized controlled trial
ipilimumab plus dacarbazine
ipilimumab plus dacarbazine (10 mg per kilogram plus 850 mg per square meter of body-surface area) given at weeks 1, 4, 7, and 10, followed by dacarbazine alone every 3 weeksthrough week 22.
dacarbazine plus placebo
dacarbazine (850 mg per square meter) plus placebo given at weeks 1, 4, 7, and 10, followed by dacarbazine alone every 3 weeks through week 22.
No cross over, they were eligible to enter a maintenance phase in which they received placebo or ipilimumab every 12 weeks.
mML - L2 - all population
patients were ineligible if they had evidence of brain metastasis (as confirmed on imaging), primary ocular or mucosal melanoma, or autoimmune disease
double-blind
multinational
P3/ two sided test procedure without interim analysis. A hierarchical testing procedure was implemented in the order of the following end points: overall survival, progression- free survival, rate of disease control, and rate of best overall response
Ipilimumab (at a dose of 10 mg per kilogram) in combination with dacarbazine, ascompared with dacarbazine plus placebo, improved overall survival in patients withpreviously untreated metastatic melanoma.
nivolumab alone (n=272) vs. Standard of Care (SoC) (n=133)
randomized controlled trial
nivolumab
nivolumab 3 mg/kg every 2 weeks until progression or unacceptable toxic effects. We allowed treatment with nivolumab beyond progression for patients experiencing clinical benefit and tolerating the drug as established by the investigator.
chemotherapy (investigator’s choice)
dacarbazine 1000 mg/m² every 3 weeks or paclitaxel 175 mg/m² combined with carboplatin area under the curve 6 every 3 weeks). (dacarbazine,33.8%; paclitaxel,42.9%) Treatment was given open-label because of the choices available to the investigators in the ICC group
We did not allow dose reductions with nivolumab treatment (dose reductions for chemotherapy were per institutional standards of care); however, we allowed dose delays
mML - L2 - all population
patients with active brain metastases and individuals who had had previous treatment with anti-PD-1, anti-PD-L1, or anti-PD-L2 antibodies;were excluded
open-label
90 sites in 14 countries
P3/ two sided test procedure with one interim analysis. Repartition between coprimary endpoint, and hierarchy for secondary endpoints
Nivolumab demonstrated higher, more durable responses but no difference in survival compared with ICC.
pembrolizumab (10mg/kg) (n=277) vs. ipilimumab alone (n=278)
randomized controlled trial
pembrolizumab every 3 wk
pembrolizumab at a dose of 10 mg per kilogram of body weight every 3 weeks
ipilimumab
ipilimumab at a dose of 3 mg per kilogram every 3 weeks.
Although crossover was not allowed per protocol, after the second interim analysis, an external data monitoring committee recommended making pembrolizumab available to patients in KEYNOTE-006
mML - L2 - all population
Known BRAF V600 mutational status was required. Excluded from the study were patients with ocular melanoma, active brain metastases, or a history of serious autoimmune disease.
open label
16 countries
P3/ one sided test procedure with two interim analysis. 3 arms pembrolizumab 2 weeks or 3 weeks versus ipilimumab - Subgroup BRAFV600E/K status (mutant previously treated) repartition between coprimary endpoint PFS OS
Substantiating the results of the interim analyses of KEYNOTE-006, pembrolizumab continued to provide significantly superior overall survival and progression free survival versus ipilimumab, with no difference between pembrolizumab dosing schedules
pembrolizumab (10mg/kg) (n=181) vs. Standard of Care (SoC) (n=179)
randomized controlled trial
pembrolizumab
pembrolizumab 10 mg/kg given intravenously every 3 weeks
ICC (carboplatin plus paclitaxel, dacarbazine, paclitaxel alone or oral temozolomid)
(paclitaxel plus carboplatin (23.4%), paclitaxel (15.6%), carboplatin (7.2%) [eliminated with protocol amendment one], dacarbazine (25.1%) , or oral temozolomide (24.0%))
the patient could cross over (48%) to receive pembrolizumab after a washout period
mML - L2 - all population
We excluded patients with known active brain metastases.
open label
73 hospitals, clinics, and academic medical centres in 12 countries
P2/ one sided test procedure with two interim analysis. 3 arms pembrolizumab 2mg/kg, 10mg/kg vs chemotherapy. repartition PFS (0.0025/arm) and OS (0.01/arm) in one-sided
Improvement in OS with pembrolizumab was not statistically significant at either dose versus chemotherapy.
pembrolizumab (10mg/kg) 2 weeks (n=279) vs. ipilimumab alone (n=278)
randomized controlled trial
pembrolizumab every 2 wk
pembrolizumab at a dose of 10 mg per kilogram of body weight every 2 weeks
ipilimumab
ipilimumab at a dose of 3 mg per kilogram every 3 weeks.
Although crossover was not allowed per protocol, after the second interim analysis, an external data monitoring committee recommended making pembrolizumab available to patients in KEYNOTE-006
mML - L2 - all population
Known BRAF V600 mutational status was required. Excluded from the study were patients with ocular melanoma, active brain metastases, or a history of serious autoimmune disease.
open label
16 countries
P3/ one sided test procedure with two interim analysis. 3 arms pembrolizumab 2 weeks or 3 weeks versus ipilimumab - Subgroup BRAFV600E/K status (mutant previously treated) repartition between coprimary endpoint PFS OS
Substantiating the results of the interim analyses of KEYNOTE-006, pembrolizumab continued to provide significantly superior overall survival and progression free survival versus ipilimumab, with no difference between pembrolizumab dosing schedules
pembrolizumab (2mg/kg) (n=180) vs. Standard of Care (SoC) (n=179)
randomized controlled trial
pembrolizumab
pembrolizumab 2 mg/kg given intravenously every 3 weeks
ICC (carboplatin plus paclitaxel, dacarbazine, paclitaxel alone or oral temozolomid)
(paclitaxel plus carboplatin (23.4%), paclitaxel (15.6%), carboplatin (7.2%) [eliminated with protocol amendment one], dacarbazine (25.1%) , or oral temozolomide (24.0%))
A designated pharmacist at each site who was unmasked prepared the pembrolizumab dose so that it could be administered to the patient in a masked fashionthey could cross over to receive pembrolizumab after a washout period
mML - L2 - all population
Randomisation was stratifi ed by ECOG performance status (0 vs 1), lactate dehydrogenaseconcentration, and BRAF status
open label
73 hospitals, clinics, and academic medical centres in 12 countries
P2/ one sided test procedure with two interim analysis. 3 arms pembrolizumab 2mg/kg, 10mg/kg vs chemotherapy. repartition PFS (0.0025/arm) and OS (0.01/arm) in one-sided
Improvement in OS with pembrolizumab was not statistically significant at either dose versus chemotherapy.
pembrolizumab plus SoC (n=60) vs. placebo plus SoC (n=60)
randomized controlled trial
pembrolizumab, with dabrafenib and trametinib
pembrolizumab 2 mg/kg intravenously every 3 weeks intravenously every 3 weeks with dabrafenib and trametinib (dabrafenib 150 mg bid plus trametinib 2 mg qd)
placebo with dabrafenib and trametinib
Placebo Q3W with dabrafenib and trametinib (dabrafenib 150 mg bid plus trametinib 2 mg qd)
mML - L2 - BRAF mutant
BRAF mutation-positive and has received prior systemic therapy for metastatic or advanced melanoma. those who had received previous systemic therapy for metastatic or advanced melanoma were not eligible to participate
double blind
22 sites in seven countries (Australia, New Zealand, Canada, Denmark, Italy, Israel, and USA)
P2/ one sided test procedure without interim analysis. No statistic plan found exept for PE (P value of 0.0025 to be declared a statistically significant improvement in this small randomized trial. Therefore, the improvement in progressionfreesurvival is numerical and not statistically significant in the current clinical trial.)OR (Assuminga hazard ratio of 0.5, approximately 74 progression-free survival events were necessary to have 80% power to reject the null hypothesis at one-sided 0.025 type I error.)
triplet therapy with dabrafenib, trametinib and pembrolizumab did not meet its primary endpoint PFS compared with the doublet therapyof dabrafenib, trametinib and placebo
Ipilimumab (10 mg/kg) (n=511) vs. interferon alpha (n=636)
randomized controlled trial
ipilimumab 10 mg/kg
ipi3 or ipi10 was administeredintravenously every 3 weeks for 4 doses (induction),followed by the same dose every 12 weeks for up to4 additional doses (maintenance).
HDI high dose of interferon alpha
HDI was administered intravenously at 20 million units/m2 of body surface area per day, 5 days per week, for 4 weeks (induction), followed by 10 million units/m2 per day subcutaneously every other day, 3 days per week, for 48 weeks (maintenance).
mML - NA - all population
open label
United States and Canada.
P3/ one sided and four interim analysis (OS). A 2-step hierarchic approach first evaluated ipi3 versus HDI followed by ipi10 versus HDI. Because no interim analyses had been conducted before this revision, this change did not affectthe overall type I error rate of the study design. With a 1-sidedtype I error rate of 0.022 for OS and 0.003 for RFS.
Adjuvant therapy with ipi3 benefits survival versus HDI. The currently approved adjuvant ipilimumab dose (ipi10) was more toxic and not superior in efficacyto HDI.
Ipilimumab (10 mg/kg) (n=475) vs. placebo (n=476)
randomized controlled trial
ipilimumab
intravenous infusions of 10 mg/kg ipilimumab every 3 weeks for four doses, then every 3 months for up to 3 years.
placebo
intravenous infusions of placebo every 3 weeks for four doses, then every 3 months for up to 3 years.
No dose reductions or modifications were made.
mML - NA - all population
patients with stage III cutaneous melanoma (excluding lymph node metastasis ≤1 mm or in-transit metastasis) with adequate resection of lymph nodes (ie, the primary cutaneous melanoma must have been completely excised with adequate surgical margins)
double-blind
91 hospitals located in 19 countries
P3/ two sided test procedure without interim analysis. Hierarchical testing procedure : RFS (0.05) then final analysis OS (0.049) and MFS (0.042)
Adjuvant ipilimumab significantly improved RFS, OS and MFS for patients with completely resected high-risk stage III melanoma.
ipilimumab alone (n=523) vs. interferon alpha (n=636)
randomized controlled trial
ipilimumab 3 mg/kg
ipi3 or ipi10 was administeredintravenously every 3 weeks for 4 doses (induction),followed by the same dose every 12 weeks for up to4 additional doses (maintenance).
HDI high dose of interferon alpha
HDI was administered intravenously at 20 million units/m2 of body surface area per day, 5 days per week, for 4 weeks (induction), followed by 10 million units/m2 per day subcutaneously every other day, 3 days per week, for 48 weeks (maintenance).
mML - NA - all population
open label
United States and Canada.
P3/ one sided and four interim analysis (OS). A 2-step hierarchic approach first evaluated ipi3 versus HDI followed by ipi10 versus HDI. Because no interim analyses had been conducted before this revision, this change did not affectthe overall type I error rate of the study design. With a 1-sidedtype I error rate of 0.022 for OS and 0.003 for RFS.
Adjuvant therapy with ipi3 benefits survival versus HDI. The currently approved adjuvant ipilimumab dose (ipi10) was more toxic and not superior in efficacyto HDI.
nivolumab alone (n=453) vs. Ipilimumab (10 mg/kg) (n=453)
randomized controlled trial
nivolumab
nivolumab at a dose of 3 mg per kilogram of body weight every 2 weeks
ipilimumab
ipilimumab at a dose of 10 mg per kilogram every 3 weeks for four doses and then every 12 weeks
traetment along with corresponding matching placebo
mML - NA - all population
double-blind
130 centers in 25 countries
P3/ two sided test procedure with one interim analysis. The critical hazard ratio was 0.78 with an adjusted alpha level of 0.0244 (two-sided). (no other strategy in SAP)
Among patients undergoing resection of stage IIIB, IIIC, or IV melanoma, adjuvant therapy with nivolumab resulted in significantly longer recurrence-free survival and a lower rate of grade 3 or 4 adverse events than adjuvant therapy with ipilimumab
nivolumab alone (n=59) vs. placebo (n=52)
randomized controlled trial
nivolumab
nivolumab monotherapy group (3 mg/kg of intravenous nivolumab every 2 weeks plus ipilimumab-matching placebo during weeks 1–12)
placebo
double-matching placebo group
mML - NA - all population
double-blind
20 german academic medical centres
P2/ two sided and one interim analysis. Repartition alpha between two arms (0.025/arm) (nivolumab plus ipilimumab and nivolumab versus placebo) no statistical plan for the comparaison between nivolumab plus ipilimumab and nivolumab )
Adjuvant therapy with nivolumab alone or in combination with ipilimumab increased recurrence-free survival significantly compared with placebo in patients with stage IV melanoma with no evidence of disease
nivolumab plus ipilimumab (n=56) vs. nivolumab alone (n=59)
randomized controlled trial
nivolumab plus ipilimumab
nivolumab plus ipilimumab group (1 mg/kg of intravenous nivolumab every 3 weeks plus 3 mg/kg of intravenous ipilimumab every 3 weeks for four doses, followed by 3 mg/kg of nivolumab every 2 weeks)
nivolumab
3 mg/kg of nivolumab every 2 weeks (plus ipilimumab-matching placebo during weeks 1–12
For patients with disease recurrence receiving nivolumab-matching placebo plus ipilimumabmatching placebo, crossover to nivolumab was allowed
mML - NA - all population
double-blind
20 german academic medical centres
P2/ two sided and one interim analysis. Repartition alpha between two arms (0.025/arm) (nivolumab plus ipilimumab and nivolumab versus placebo) no statistical plan for the comparaison between nivolumab plus ipilimumab and nivolumab )
exploratory results only
nivolumab plus ipilimumab (n=-9) vs. nivolumab alone (n=-9)
randomized controlled trial
nivolumab plus ipilimumab
240 mg of nivolumab intravenously every 2 weeks and 1 mg/kg of ipilimumab every 6 weeks for up to 1 year.
nivolumab
480 mg of nivolumab every 4 weeks for up to 1 year.
mML - NA - all population
double-blind
P3/
Qualitative results realeased in BMS news in october 2020 : Statistically significant benefit was not reached for the co-primary endpoint of recurrence-free survival (RFS) in patients whose tumors expressed PD-L1 <1% (2019 results) and in the all-comer (intent-to-treat) (2020 results).
nivolumab plus ipilimumab (n=56) vs. placebo (n=52)
randomized controlled trial
nivolumab plus ipilimumab
nivolumab plus ipilimumab group (1 mg/kg of intravenous nivolumab every 3 weeks plus 3 mg/kg of intravenous ipilimumab every 3 weeks for four doses, followed by 3 mg/kg of nivolumab every 2 weeks)
placebo
double-matching placebo group
For patients with disease recurrence receiving nivolumab-matching placebo plus ipilimumabmatching placebo, crossover to nivolumab was allowed
mML - NA - all population
double-blind
20 german academic medical centres
P2/ two sided and one interim analysis. Repartition alpha between two arms (0.025/arm) (nivolumab plus ipilimumab and nivolumab versus placebo) no statistical plan for the comparaison between nivolumab plus ipilimumab and nivolumab )
Adjuvant therapy with nivolumab alone or in combination with ipilimumab increased recurrence-free survival significantly compared with placebo in patients with stage IV melanoma with no evidence of disease
pembrolizumab alone (n=514) vs. placebo (n=505)
randomized controlled trial
pembrolizumab
pembrolizumab 200 mg intravenously (IV) on Day 1 of each 21-day cycle for up to 1 year
placebo
placebo every 3 weeks for a total of 18 doses (approximately 1 year)
patients were eligible for crossover or repeat treatment with pembrolizumab
mML - NA - all population
Membranous PD-L1 expression in tumor and tumor-associated immune cells was assessed by an immunohistochemistry assay and scored on a scale of 0-5; a score >=2 (staining on . 1% of cells) was considered PD-L1 positive
double-blind
123 centers in 23 countries
P3/ one sided test procedure with one interim analysis. Hierarchy RFS (ITT then PDL1) DMFS (ITT then PDL1) AND OS (ITT then PDL1) A SUIVRE
As adjuvant therapy for high-risk stage III melanoma, pembrolizumab resulted in significantly longer RFS and DMFS than placebo and provided a sustained and clinically meaningful improvement in RFS at 5-year median follow-up
pembrolizumab alone (n=428) vs. placebo (n=425)
randomized controlled trial
pembrolizumab
pembrolizumab 200 mg intravenously (IV) on Day 1 of each 21-day cycle for up to 1 year
placebo
placebo every 3 weeks for a total of 18 doses (approximately 1 year)
patients were eligible for crossoveror repeat treatment with pembrolizumab
mML - NA - PDL1 positive
Membranous PD-L1 expression in tumor and tumor-associated immune cells was assessed by an immunohistochemistry assay and scored on a scale of 0-5; a score >=2 (staining on . 1% of cells) was considered PD-L1 positive
double-blind
123 centers in 23 countries
P3/ one sided test procedure with one interim analysis. Hierarchy RFS (ITT then PDL1) MFS (ITT then PDL1) AND OS (ITT then PDL1) A SUIVRE
As adjuvant therapy for high-risk stage III melanoma, pembrolizumab resulted in significantly longer RFS and DMFS than placebo and provided a sustained and clinically meaningful improvement in RFS at 5-year median follow-up. Same results were observed in the PDL1 positive population.
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