Improved clinical outcomes with low-dose anti-CTLA-4 (Nurulimab) plus anti-PD-1 (Prolgolimab) vs. anti-PD-1 monotherapy in advanced cutaneous melanoma: Results from the phase III OCTAVA trial.

BACKGROUND: OCTAVA (NCT05732805) was an international, multi-center, randomized, double-blind, phase III study evaluating the fixed-dose combination of nurulimab (anti-CTLA-4) and prolgolimab (anti-PD-1) (BCD-217, Nuru+Prolgo) followed by prolgolimab maintenance versus prolgolimab monotherapy as first-line treatment for unresectable or metastatic melanoma (un/mM). We present the primary analysis results. METHODS: Treatment-naïve patients with un/mM were randomized 1:1 to Nuru+Prolgo (n = 135) or prolgolimab (n = 136) for 4 cycles, followed by prolgolimab maintenance for up to two years. The primary endpoint was progression-free survival (PFS) by iRECIST. RESULTS: With a median follow-up of 15.8 months, median PFS was significantly longer with nurulimab+prolgolimab [15.4 months (95 % CI, 10.3-ND)] compared to prolgolimab monotherapy [10.8 months (4.7-ND)] (HR 0.68; 95 % CI, 0.482-0.957; iRECIST). RECIST 1.1 analysis confirmed this benefit (mPFS 9.9 vs 2.8 months). ORR and DCR were also higher in the combination arm. Grade 3-4 treatment-related AE: 16.3 % (combination) vs 14.0 % (monotherapy). Immune-related AEs (irAE): 52.6 % vs 32.4 % (p = 0.0007); Gr. ≥ 3 irAE: 13.3 % vs 5.9 % (p = 0.04). Discontinuations due to AE: 9.6 % vs 4.4 %. CONCLUSIONS: The Nuru+Prolgo fixed-dose combination demonstrated significantly superior efficacy versus aPD-1 monotherapy in first-line un/mM, with a manageable safety profile.