Top Line: After nearly a decade of follow-up, does adjuvant nivolumab still beat ipilimumab for resected high-risk melanoma?
The Study: Today we bring you long-term outcomes nearly a decade after completion of CheckMate 238, a phase 3 double-blind trial randomizing 906 patients with completely resected stage IIIB-IV melanoma to adjuvant nivolumab (3 mg/kg q2w) versus ipilimumab (10 mg/kg q3w x 4 then q12w) for up to one year. Earlier analyses established nivo offers superior recurrence-free survival with less toxicity. Here median recurrence-free survival remained substantially longer with nivolumab (61 vs 24 months). Distant metastasis–free survival similarly favored nivo (54% vs 48%). Ultimately, there was no significant difference in the rate of melanoma death at 9 years (26% vs 30%), presumably due to effective salvage. This leads an accompanying editorial to question whether anyone should be treated adjuvantly in the first place when instead early salvage can be pursued only for those who prove to require it. A final intriguing post-hoc analysis of circadian timing of dosing (i.e., before or after 1 p.m.) did not reveal any impact on outcomes, which the authors stipulate may be explained by the absence of macroscopic tumor in this trial.
TBL: Adjuvant nivo, as opposed to ipi, delivers decade-long improvements in disease control but effective salvage therapies diminish overall survival gains. | Ascierto, N Engl J Med 2026 & Chapman, N Engl J Med 2026
The Study: Today we bring you long-term outcomes nearly a decade after completion of CheckMate 238, a phase 3 double-blind trial randomizing 906 patients with completely resected stage IIIB-IV melanoma to adjuvant nivolumab (3 mg/kg q2w) versus ipilimumab (10 mg/kg q3w x 4 then q12w) for up to one year. Earlier analyses established nivo offers superior recurrence-free survival with less toxicity. Here median recurrence-free survival remained substantially longer with nivolumab (61 vs 24 months). Distant metastasis–free survival similarly favored nivo (54% vs 48%). Ultimately, there was no significant difference in the rate of melanoma death at 9 years (26% vs 30%), presumably due to effective salvage. This leads an accompanying editorial to question whether anyone should be treated adjuvantly in the first place when instead early salvage can be pursued only for those who prove to require it. A final intriguing post-hoc analysis of circadian timing of dosing (i.e., before or after 1 p.m.) did not reveal any impact on outcomes, which the authors stipulate may be explained by the absence of macroscopic tumor in this trial.
TBL: Adjuvant nivo, as opposed to ipi, delivers decade-long improvements in disease control but effective salvage therapies diminish overall survival gains. | Ascierto, N Engl J Med 2026 & Chapman, N Engl J Med 2026