IMPACT OF COMBINED THERAPY WITH NIVOLUMAB AND IPILIMUMAB COMPARED TO CONVENTIONAL TREATMENTS ON SURVIVAL OF PATIENTS WITH ADVANCED MELANOMA: A SYSTEMATIC REVIEW OF THE EVIDENCE

Abstract

This article aimed to evaluate the impact of combined therapy with nivolumab and ipilimumab compared to conventional treatments on the survival of patients with advanced melanoma. A systematic review of the literature was conducted using the PICO strategy, with searches in databases from 2016 to 2026, considering randomized clinical trials and observational studies. Ultimately, 10 eligible articles were included for analysis. The results demonstrated that combined therapy with nivolumab and ipilimumab exhibits consistent superiority in overall survival compared to monotherapy, achieving 52% survival at 5 years versus 26% with ipilimumab alone and 44% with nivolumab (HR 0.52; p < 0.001). The median overall survival exceeded 60 months in the combined therapy group. However, this benefit is associated with a significant increase in grade 3 or 4 adverse events, occurring in 53% to 59% of patients compared to 20-28% in monotherapy groups. The benefit was more pronounced in treatment-naïve patients and those with asymptomatic brain metastases. It is concluded that, although the combination represents significant progress in advanced melanoma treatment, its use requires careful patient selection and rigorous management of immunotherapy-related toxicity.