ctDNA-guided Addition of Ipilimumab to Patients Receiving Nivolumab and Relatlimab

This study's approach seeks to rationally, rather than empirically, choose one treatment approach over another, as well as to develop methods to predict disease recurrence at earlier time points. The combination of ipilimumab and nivolumab is the standard of care for first-line treatment of advanced melanoma. This study instead seeks to pioneer treatment choice based on evidence of molecular relapse, and to determine whether this results in superior outcomes compared with the current standard of care to treat until evidence of radiologic progression. Patients with sustained "zeroconversion" may not require an immediate switch, while patients whose ctDNA levels are detectable and/or rising may benefit from an earlier therapeutic switch. The overall goal is to improve patient selection for therapy, thus sparing the therapeutic and financial toxicities from therapies that have stopped working (i.e. patients with rising ctDNA levels) or are perhaps not necessary (patients who have sustained zeroconversion).