# CheckMate 238: adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma

Source: https://onco.cc/key-papers/paper-checkmate-238-nejm-2017/  
OnCo record `paper-checkmate-238-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A year of adjuvant nivolumab after surgery for high-risk melanoma reduced recurrences more than the previous standard, high-dose ipilimumab, with a quarter of the severe toxicity, making PD-1 blockade the adjuvant standard.

## Summary

Phase 3 trial of 906 patients with resected stage IIIB, IIIC or IV melanoma randomised to nivolumab or ipilimumab 10 mg/kg for one year.

Twelve-month recurrence-free survival was 70.5 versus 60.8 percent (hazard ratio 0.65), with grade 3 to 4 treatment-related adverse events in 14.4 versus 45.9 percent; four-year recurrence-free survival was 51.7 versus 41.2 percent, with no overall survival difference.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1709030
- Authors: Weber J, Mandala M, Del Vecchio M, et al.
- Findings: Twelve-month recurrence-free survival 70.5 percent vs 60.8 percent; hazard ratio 0.65.; Grade 3 to 4 adverse events 14.4 percent vs 45.9 percent.
- What it means: Adjuvant nivolumab (or pembrolizumab) is standard for resected stage III and IV melanoma; ipilimumab is no longer used in the adjuvant setting.
- Caveats: No placebo arm; the comparison is against an active but toxic agent.; Overall survival did not differ, probably because of effective therapy at relapse.

## Sources

- N Engl J Med 2017: https://doi.org/10.1056/NEJMoa1709030
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28891423/

## Connected records

- cancers: [Stage III melanoma (after surgery)](https://onco.cc/cancers/stage-iii-melanoma/)
- drugs: [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/)
- trials: [CheckMate 238](https://onco.cc/trials/checkmate-238/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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