# Combined Anti-PD-1 and Anti-CTLA-4 Treatment in Stage IV Melanoma Patients: A Bicentric Analysis of Real-World Data and a Modern Treatment Scenario Proving Lactate Dehydrogenase’s Usefulness

## TL;DR

This study examines the effectiveness and safety of combining two immunotherapies in advanced melanoma patients, showing real-world survival data and the role of lactate dehydrogenase as a marker.

## Contribution

The study provides real-world evidence supporting the use of lactate dehydrogenase as a useful biomarker in combination immunotherapy for stage IV melanoma.

## Key findings

- Patients with three or more metastases had significantly higher lactate dehydrogenase levels before treatment.
- Median overall survival was 346 days and median progression-free survival was 211 days in treated patients.
- About 45.3% of patients experienced adverse events during combination therapy.

## Abstract

Background: This retrospective study evaluates patients with stage IV melanoma treated with nivolumab and ipilimumab combination therapy from two regional oncology centers in Romania from the year 2019 to the end of 2022. Methods: The data were analyzed in SAS for Windows, V9.4. LDH means were stratified by the number of metastatic sites before treatment and compared using an independent sample T-test. The survival curves were estimated using the Kaplan–Meier method, and the survival distributions were compared with the log-rank test. The effects of the main clinical and pathological variables on OS and PFS were investigated with Cox regression. Results: The LDH mean for patients with three or more metastases before treatment was significantly higher than that for patients with only one metastatic site. The Kaplan–Meier curve of OS in all evaluable patients enrolled in the study resulted in a median OS of 346 days (95% CI: 150) and a median PFS of 211 days (95% CI: 113–430). A total of 45.3% of the patients experienced adverse events during the nivolumab + ipilimumab treatment, with some of them having multiple organ systems involved. Discussion: The OS values were lower than those reported in approved clinical trials, but the results show a marked improvement when compared to the results obtained by chemotherapy regimens previously used in these scenarios. Conclusion: This study provides real-world insights into the survival data and safety profiles of combination therapy with anti-PD-1 antibodies and anti-CTLA-4 antibodies.