Dr. Glitza Oliva on Intrathecal/Intravenous Nivolumab in Metastatic Melanoma/Leptomeningeal Disease

Isabella C. Glitza Oliva, MD, PhD, MS, assistant professor, Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the rationale for concurrent intrathecal (IT) and intravenous (IV) nivolumab (Opdivo) in patients with metastatic melanoma who have leptomeningeal disease.

IT interleukin-2 (IL-2) was used in metastatic melanoma prior to the advent of checkpoint inhibitors, says Glitza Oliva.

IL-2 administered by vein elicited prolonged survival in about 10% to 15% of patients with metastatic melanoma, says Glitza Oliva. However, IT IL-2 administered directly into the spinal fluid is associated with significant toxicities.

Single-agent nivolumab or pembrolizumab (Keytruda) have demonstrated better responses with less toxicity compared with IL-2 administered by vein, says Glitza Oliva.

As such, concurrent IV and IT nivolumab may have activity in metastatic melanoma, specifically for the subset of patients with leptomeningeal disease, concludes Glitza Oliva.