When would you offer nivolumab/relatlimab to a metastatic melanoma patient following progression on BRAF/MEK targeted therapy?

It depends on what previous therapies have been used. If this patient has already progressed on anti-PD1 monotherapy and BRAF/MEK inhibitor, then TIL therapy should be explored. I would use IPI-3 and NIVO-1 as a bridge in that scenario, after harvest (can start before harvest as well if a date is not immediately available).

Nivo-Rela does not have an established track record compared to Ipi and Nivo (DreamSeq and Secombit trials), although smaller studies and anecdotal data show some efficacy. Such patients also tend to progress rapidly in the brain; hence, I always screen them for brain metastasis. In either scenario, using IPI 3 and NIVO 1 would be the best choice in my opinion.