Stereotactic Radiosurgery and Ipilimumab for Melanoma Brain Metastases

Conference Correspondent - ASCO 2014 - Immuno-Oncology


Stereotactic radiosurgery (SRS) and ipilimumab (IPI) have been administered to patients with melanoma brain metastases with the goal of improving outcomes, including overall survival (OS). A retrospective chart review published in 2012 showed that receipt of IPI and radiosurgery for melanoma brain metastases was associated with enhanced survival. Of the 77 patients treated with SRS between 2002 and 2010, 35% had also received IPI. Among patients with melanoma brain metastases who did not receive IPI, median OS was 4.9 months, compared with 21.3 months in those who received IPI.1 Two-year survival rates were 20% versus 47%, respectively.1

To validate these findings, Shoukat and colleagues (ASCO 2014; Abstract 9076) retrospectively assessed survival outcomes among patients with melanoma brain metastases who underwent SRS between 1998 and 2012 and who did not receive IPI (n = 176) compared with those who received IPI (n = 38). Median OS for the full cohort was 9.0 months after a median follow-up of 41.2 months. Patients with melanoma brain metastases who received IPI had significantly longer median OS (28.0 months) compared with the non-IPI group (7.0 months) (P <.001). Toxicities, including necrosis, hemorrhage, and patient-reported memory deficits, were comparable between groups, as was the need for repeated SRS. Multivariate analysis showed that IPI independently predicted for improved OS, even when considering lactic dehydrogenase and ECOG performance status.

Shoukat et al concluded that use of SRS with IPI in patients with melanoma brain metastases appears safe and was associated with a clinically- and statically-significant increase in OS. They recommended further investigation of SRS with IPI in this subgroup.

Reference

  1. Knisely JP, Yu JB, Flanigan J, Sznol M, Kluger HM, Chiang VL. Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival. J Neurosurg. 2012;117(2):227-233.