About Metastatic Melanoma

No one is ever ready to hear that they have metastatic melanoma, or melanoma that’s inoperable, even if they’ve had a melanoma diagnosis in the past.

If you or a loved one find you’re still struggling to understand what it all means, it may help to break down the diagnosis by each word. Understanding is your first step in defining the path forward that fits your personal goals.

  • Melanoma is a form of skin cancer. There are different forms of skin cancer, but melanoma is the most serious. Melanoma can spread very quickly to other parts of the body, so it is important to detect and treat melanoma in its early stages
  • Metastatic means that your cancer (in this case, melanoma) has spread. Generally, cancer cells do not remain still or “static” and instead, may travel to other parts of your body—either through your bloodstream or lymph nodes. At some point, these cells can start dividing and form new tumors in new areas. The new tumors can be linked back to the melanoma because they contain similar cells
  • Inoperable is sometimes referred to as “unresectable”. Both terms mean that the tumor or tumors can’t be removed by surgery, either because it's spread to too many places or, based on the location, it’s not safe to operate

HOW IS YOUR MELANOMA STAGE DETERMINED?

Most cancers, including melanoma, are divided into different groups called stages, based on a system developed by oncologists. There are 5 main stages from 0 to 4. Your oncologist may determine the stage of your melanoma by reviewing one or all of a number of factors including your medical history, a physical exam, blood work, and/or a biopsy.

In addition to numbers, doctors also use a system called a TNM staging system. In this system, each of the letters—T, N, and M— describe a different way to measure the growth of your melanoma. The stage of your melanoma is based on a combination of measurements from all of these categories.

T
How THICK the
main tumor is
N
The NUMBER of lymph nodes involved to determine how far the cancer has spread
M
Whether the same
cancer cells have
METASTASIZED
or moved to
distant organs

If you are diagnosed with metastatic melanoma that means your cancer has already spread. You may be told that it is unresectable, which means that surgery will not be able to remove it, either due to its location, how much it has spread, or because it may not be safe to operate.


METASTATIC MELANOMA
TREATMENT OPTIONS

During the course of your treatment with metastatic melanoma, you may have
been treated with:

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Talking With Your Doctor Is Key

Review a list of questions with your
oncologist about whether OPDIVO + YERVOY is right for you.

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SELECT IMPORTANT FACTS ABOUT OPDIVO AND YERVOY

OPDIVO is a medicine that may treat certain cancers by working with your immune system. OPDIVO can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become serious or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended. Some of these problems may happen more often when OPDIVO is used in combination with YERVOY.

YERVOY can cause serious side effects in many parts of your body which can lead to death. These problems may happen anytime during treatment with YERVOY or after you have completed treatment.

Important Safety Information
for OPDIVO® (nivolumab) and
the OPDIVO+YERVOY® (ipilimumab) Regimen

OPDIVO is a medicine that may treat certain cancers by working with your immune system. OPDIVO can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become serious or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended. Some of these problems may happen more often when OPDIVO is used in combination with YERVOY.

YERVOY can cause serious side effects in many parts of your body which can lead to death. These problems may happen anytime during treatment with YERVOY or after you have completed treatment.

Serious side effects may include:

  • Lung problems (pneumonitis). Symptoms of pneumonitis may include: new or worsening cough; chest pain; and shortness of breath.
  • Intestinal problems (colitis) that can lead to tears or holes in your intestine. Signs and symptoms of colitis may include: diarrhea (loose stools) or more bowel movements than usual; blood in your stools or dark, tarry, sticky stools; and severe stomach area (abdomen) pain or tenderness.
  • Liver problems (hepatitis). Signs and symptoms of hepatitis may include: yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); drowsiness; dark urine (tea colored); bleeding or bruising more easily than normal; feeling less hungry than usual; and decreased energy.
  • Hormone gland problems (especially the thyroid, pituitary, adrenal glands, and pancreas). Signs and symptoms that your hormone glands are not working properly may include: headaches that will not go away or unusual headaches; extreme tiredness; weight gain or weight loss; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness; hair loss; feeling cold; constipation; voice gets deeper; and excessive thirst or lots of urine.
  • Kidney problems, including nephritis and kidney failure. Signs of kidney problems may include: decrease in the amount of urine; blood in your urine; swelling in your ankles; and loss of appetite.
  • Skin Problems. Signs of these problems may include: rash; itching; skin blistering; and ulcers in the mouth or other mucous membranes.
  • Inflammation of the brain (encephalitis). Signs and symptoms of encephalitis may include: headache; fever; tiredness or weakness; confusion; memory problems; sleepiness; seeing or hearing things that are not really there (hallucinations); seizures; and stiff neck.
  • Problems in other organs. Signs of these problems may include: changes in eyesight; severe or persistent muscle or joint pains; severe muscle weakness; and chest pain.

Additional serious side effects observed during a separate study of YERVOY alone include:

  • Nerve problems that can lead to paralysis. Symptoms of nerve problems may include: unusual weakness of legs, arms, or face; and numbness or tingling in hands or feet.
  • Eye problems. Symptoms may include: blurry vision, double vision, or other vision problems; and eye pain or redness.

Getting medical treatment right away may keep these problems from becoming more serious.

Your healthcare provider will check you for these problems during treatment. Your healthcare provider may treat you with corticosteroid or hormone replacement medicines. Your healthcare provider may also need to delay or completely stop treatment, if you have severe side effects.

OPDIVO can cause serious side effects, including:

  • Severe infusion reactions. Tell your doctor or nurse right away if you get these symptoms during an infusion of OPDIVO: chills or shaking; itching or rash; flushing; difficulty breathing; dizziness; fever; and feeling like passing out.

Pregnancy and Nursing:

  • Pregnancy Safety Surveillance Study: Females who become pregnant during treatment with YERVOY are encouraged to enroll in a Pregnancy Safety Surveillance Study. The purpose of this study is to collect information about the health of you and your baby. You or your healthcare provider can enroll in the Pregnancy Safety Surveillance Study by calling 1-844-593-7869.
  • Before receiving treatment, tell your healthcare provider if you are breastfeeding or plan to breastfeed. It is not known if either treatment passes into your breast milk. Do not breastfeed during treatment and for 3 months after the last dose of YERVOY.

Tell your healthcare provider about:

  • Your health problems or concerns if you: have immune system problems such as autoimmune disease, Crohn’s disease, ulcerative colitis, lupus, or sarcoidosis; have had an organ transplant; have lung or breathing problems; have liver problems; or have any other medical conditions.
  • All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

The most common side effects of OPDIVO when used alone include: feeling tired; pain in muscles, bones, and joints; diarrhea; weakness; shortness of breath; decreased appetite; upper respiratory tract infection; headache; rash; itchy skin; nausea; cough; constipation; back pain; fever; and stomach pain.

The most common side effects of OPDIVO, when used in combination with YERVOY, include: feeling tired; diarrhea; fever; shortness of breath; itching; decreased appetite; rash; nausea; vomiting; pain in muscles, bones, and joints; and cough. The most common side effects of YERVOY include: tiredness; diarrhea; itching; rash; nausea; vomiting; headache; weight loss; fever; decreased appetite; and difficulty falling or staying asleep.

These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call . You may also report side effects to Bristol-Myers Squibb at .


Please see U.S. Full Prescribing Information, including Boxed WARNING regarding immune-mediated side effects, and Medication Guide for YERVOY.

Please see U.S. Full Prescribing Information and Medication Guide for OPDIVO.