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Journal of Translational Medicine

Open Access

Nivolumab improved survival vs dacarbazine in patients with untreated advanced melanoma

  • Georgina V Long1,
  • Victoria Atkinson2,
  • Paolo A Ascierto3,
  • Benjamin Brady4,
  • Caroline Dutriaux5,
  • Michele Maio6,
  • Laurent Mortier7,
  • Jessica C. Hassel8,
  • Piotr Rutkowski9,
  • Catriona McNeil10,
  • Ewa Kalinka-Warzocha11,
  • Kerry J. Savage12,
  • Micaela Hernberg13,
  • Celeste Lebbé14,
  • Julie Charles15,
  • Catalin Mihalcioiu16,
  • Vanna Chiarion-Sileni17,
  • Cornelia Mauch18,
  • Henrik Schmidt19,
  • Dirk Schadendorf20,
  • Helen Gogas21,
  • Christine Horak22,
  • Brian Sharkey23,
  • Ian M. Waxman22 and
  • Caroline Robert24
Journal of Translational Medicine201513(Suppl 1):O6

Published: 15 January 2015


Overall SurvivalDacarbazineImmune CheckpointCheckpoint InhibitorAdvanced Melanoma


The phase 1 study of nivolumab, a fully human IgG4 programmed death-1 (PD-1) immune checkpoint inhibitor monoclonal antibody, showed promising antitumor activity in patients with advanced melanoma.

Materials and methods

This phase 3 study compared nivolumab vs dacarbazine in treatment-naïve patients with BRAF wild-type metastatic melanoma. Patients were randomized 1:1 to receive nivolumab 3 mg/kg every 2 weeks (Q2W) + placebo Q3W (n = 210) or dacarbazine 1000 mg/m2 Q3W + placebo Q2W (n = 208) until disease progression or unacceptable toxicity. Randomization was stratified by M-stage and programmed death ligand-1 (PD-L1) status. The primary endpoint was overall survival (OS). Patients were followed for up to 16.7 months at the time of data cutoff, which occurred 5.2 months after the first visit of the last patient randomized.


The hazard ratio (HR) for death was 0.42 (99.79% CI 0.25–0.73; P < 0.0001) in favor of nivolumab, with 1-year OS rate 73% (95% CI, 66%–79%) for nivolumab vs 42% (95% CI, 33%–51%) for dacarbazine. Median OS was not reached for nivolumab and was 10.8 months for dacarbazine. Median progression-free survival (PFS) was 5.1 months for nivolumab and 2.2 months for dacarbazine (HR for death or progression 0.43, 95% CI 0.34–0.56; P < 0.0001). Objective response rate was 40% (84/210) vs 14% (29/208) for nivolumab and dacarbazine, respectively (P < 0.0001). Median duration of response was not reached for nivolumab and 6 months for dacarbazine. At the time of data cutoff, responses were ongoing in 86% (72/84) of nivolumab and 52% (15/29) of dacarbazine responders. PD-L1 positivity (using a 5% tumor cell surface staining cutoff) appeared to be associated with improved OS in the nivolumab arm (85% of PD-L1+ and 71% of PD-L1-/indeterminate patients alive at the time of last follow-up). Both PD-L1+ and PD-L1-/indeterminate patients receiving nivolumab had improved OS vs dacarbazine (un-stratified HR 0.30, 95% CI, 0.15–0.60 in PD-L1+ patients; 0.48, 95% CI, 0.32–0.71 in PD-L1-/indeterminate patient, both in favor of the nivolumab arm). The most common nivolumab-related adverse events (AEs) were fatigue, pruritus, and nausea. Drug-related grade 3–4 AEs were reported in 12% vs 18% of patients receiving nivolumab vs dacarbazine, respectively. AEs led to discontinuation in 7% and 12% of dacarbazine- vs nivolumab-treatment patients, respectively.


Compared to dacarbazine, nivolumab significantly improved OS and PFS in previously untreated patients with BRAF wild-type metastatic melanoma with an acceptable safety profile.

Clinical trial registration number


Authors’ Affiliations

Melanoma Institute Australia, University of Sydney, and Mater Hospital, Sydney, Australia
Princess Alexandra Hospital, Wooloongabba & Gallipoli Medical Research Foundation, Greenslopes Private Hospital Queensland, Australia
Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
Cabrini Health, Melbourne, Australia
Hôpital Saint André CHU, Bordeaux, France
University Hospital of Siena, Siena, Italy
Hôpital Claude Huriez, Lille, France
University Hospital Heidelberg & National Center for Tumor Diseases, Heidelberg, Germany
Maria Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
Chris O'Brien Lifehouse, The Melanoma Institute Australia & Royal Prince Alfred Hospital, Camperdown, Australia
Wojewodzki Szpital Specjalistyczny im. M. Kopernika, Lodz, Poland
British Columbia Cancer Agency, Vancouver, Canada, Canada
Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
APHP Dermatology and CIC Hôpital Saint Louis Paris 7 University, INSERM 976, Paris, France
Grenoble University Hospital Grenoble France - INSERM U823, Joseph Fourier University, Grenoble, France
Royal Victoria Hospital, Alberta, Canada
Oncology Institute of Veneto IRCCS, Padua, Italy
Department of Dermatology, University Hospital Cologne and CIO Köln Bonn, Germany
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
Department of Dermatology, University of Essen, Essen, Germany
University of Athens Medical School, Laiko General Hospital, Athens, Greece
Bristol-Myers Squibb, Lawrenceville, USA
Bristol-Myers Squibb, Wallingford, USA
Gustave, Roussy and INSERM U981, Villejuif-Paris-Sud, France


© Long et al; licensee BioMed Central Ltd. 2015

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