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Ipilimumab in pretreated patients with unresectable or metastatic cutaneous, uveal and mucosal melanoma

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Australia has the highest incidence of melanoma in the world; melanoma is the fourth most common form of cancer in Australia and the most common cancer in young Australians aged 15–39 years.1 While surgery remains the mainstay of treatment for early stage melanomas, there have been limited treatment options for more advanced disease and, historically, 5-year survival was less than 15%.2

Ipilimumab (Yervoy, Bristol-Myers Squibb) is a fully humanised monoclonal antibody directed against the cytotoxic T lymphocyte antigen 4 and the first treatment to demonstrate a survival benefit in advanced and metastatic disease (see Appendix 1 for a summary of published data). Pivotal studies of ipilimumab at 3 mg/kg in relapsed disease and 10 mg/kg in untreated disease demonstrated significant overall survival (OS) advantage compared with comparative arms (ipilimumab 3 mg/kg v vaccine: median OS, 10.1 v 6.4 months; hazard ratio for death, 0.66; = 0.003;3 and 10 mg/kg plus dacarbazine v dacarbazine alone: median OS, 11.2 v 9.1 months; hazard ratio for death, 0.72; < 0.0014). Ipilimumab has demonstrated clinical activity independent of negative prognostic…