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December 2017

Adjuvant Ipilimumab for Melanoma—The $1.8 Million per Patient Regimen

Author Affiliations
  • 1Davidoff Cancer Center, Rabin Medical Center, Petach Tikvah, Israel
  • 2Winship Cancer Institute, Emory University, Atlanta, Georgia
JAMA Oncol. 2017;3(12):1628-1629. doi:10.1001/jamaoncol.2017.3123

We are all now used to hearing the broken record berating the high prices of cancer drugs. Usually such drugs cost in the region of $10 000 per month. While most expensive cancer drugs for solid tumors are used in the metastatic setting, there is currently only 1 modern immuno-oncologic agent approved in the adjuvant setting—ipilimumab for resected stage III melanoma. What is the benefit, cost, and value of this therapy?

Until recently, the standard of care for resected melanoma was treatment with interferon. However the recent results from the EORTC 18071 trial1 have changed this standard of care in the United States. This phase 3 trial compared ipilimumab (10 mg/kg) to placebo in patients who had undergone complete resection of stage III melanoma. The protocol stipulated that patients receive treatment every 3 weeks for 4 doses, then every 3 months for up to 3 years or until disease recurrence or an unacceptable level of toxic effects occurred. The 5-year rate of recurrence-free survival was 41% in the ipilimumab group and 30% in the placebo group. The 5-year overall survival was 65% in the ipilimumab group and 54% in the placebo group.1 Adjuvant ipilimumab subsequently gained US Food and Drug Administration (FDA) approval in 2015.