Quality-adjusted survival of nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone among treatment-naive patients with advanced melanoma: a quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis

PurposeTo compare the quality-adjusted survival of nivolumab plus ipilimumab combination and nivolumab alone versus ipilimumab alone among treatment-naive patients with advanced melanoma based on a minimum 36-month follow-up from the CheckMate 067 trial.MethodsOverall survival was partitioned into time without symptoms of progression or toxicity (TWiST), time with treatment-related grade3 adverse events after randomization but before progression (TOX), and time from progression until end of follow-up or death (REL). Mean quality-adjusted TWiST (Q-TWiST) was calculated by multiplying the mean time spent in each health state by a utility of 1.0 for TWiST and 0.5 for TOX and REL. Sensitivity analyses included varying utilities of TOX and REL; Q-TWiST gains at different follow-up times were calculated using EQ-5D-3L utilities from the trial. Relative Q-TWiST gain of 10% was considered clinically important.ResultsCompared with ipilimumab-treated patients, those who received nivolumab+ipilimumab combination had significantly longer TWiST and TOX but shorter REL; nivolumab-treated patients had significantly longer TWiST, shorter REL, and shorter but statistically nonsignificant TOX. Mean Q-TWiST was highest for nivolumab+ipilimumab (23.5months; 95% CI 21.9-25.2), followed by nivolumab (21.8months; 95% CI 20.2-23.4) and ipilimumab (15.3months; 95% CI 13.9-16.6). Relative Q-TWiST gains were favorable and clinically important for nivolumab+ipilimumab combination (+36.81%) and nivolumab alone (+29.18%) versus ipilimumab alone. Relative gains increased with follow-up from 3 to 40months for all comparisons. These gains remained consistent in magnitude and direction in the different sensitivity analyses.ConclusionsNivolumab+ipilimumab combination and nivolumab alone resulted in a statistically significant and clinically important improvement in quality-adjusted survival compared with ipilimumab alone.