The end of the beginning: PD-1 inhibition as the new standard of care first-line immunotherapy in metastatic melanoma

Historically, treatment options for metastatic melanoma (MM) have been limited, yielding a median overall survival (OS) of 8–10 months and a 5-year survival of less than 10% [1]. These dismal results have been radically improved due to the dramatic advances in immunotherapy for MM. The immunotherapy revolution began with the CTLA-4 inhibitor ipilimumab (Bristol Myers-Squibb, NY, USA), the first medication to show an OS benefit in MM [2,3]. Subsequently, the two PD-1 inhibitors, nivolumab (Bristol-Myers Squibb) and pembrolizumab (Merck, NJ, USA), have demonstrated efficacy in ipilimumab-treated and naïve patients, giving physicians an array of immunotherapeutic strategies (see Table 1 summary of trials) [4-10]. In 2015, clinical trials testing head-to-head and immunotherapy combinations have been reported, thus marking the beginning of the second phase of the immunotherapy revolution. Herein, we review the data in the individual, comparative and combination studies, which collectively establish PD-1 inhibition as the new choice for first-line immunotherapy in MM.

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