INTRODUCTION: The treatment of melanoma is evolving rapidly over the past few 
years. Patients with BRAFv600 mutations can be treated with a combination of a 
BRAF-inhibitor and an MEK-inhibitor. Patients with BRAF wild-type tumors and 
BRAFv600 mutated tumors can be treated with immunotherapy i.e. check point 
inhibitors.
AREAS COVERED: We conducted a comprehensive review of the literature on the 
efficacy and predictive markers, safety, and pharmacoeconomics of ipilimumab in 
melanoma Expert commentary: Ipilimumab was the first check point inhibitor 
reaching the clinic, gaining FDA and EMA approval for metastatic melanoma in 
2011. Ipilimumab was also approved by FDA in the adjuvant setting for patients 
with high risk, stage III melanoma. The anti-PD1 directed antibodies 
pembrolizumab and nivolumab are superior to single agent ipilimumab, which is no 
longer considered the standard first line treatment in metastatic melanoma. The 
addition ipilimumab to nivolumab is associated with a higher response rate and a 
better PFS, particularly in patients with PD-L1 negative tumors, albeit at the 
cost of a steep increase in grade 3-4 adverse event rate. Definitive survival 
data on this combination are pending and the selection of patients potentially 
requiring the combination and its pharmacoeconomic implications are to be 
elucidated.