Adaptive dosing of nivolumab + ipilimumab based upon interim CT scan in advanced melanoma

Nivolumab plus ipilimumab (nivo + ipi) is highly efficacious for advanced melanoma, but has high toxicity. Standard treatment is four doses of nivo + ipi followed by nivo alone, but whether four doses of nivo + ipi are needed is unclear. The multicenter phase 2 Adaptively Dosed ImmunoTherapy Trial (ADAPT-IT) found that the efficacy and toxicity of standard four dose nivo + ipi induction therapy is likely driven by the first two doses. An interim CT scan after two doses guided cessation of combination dosing and identified almost all responders. Longer follow-up is needed to fully understand the implications of a shortened induction course of nivo + ipi.