Abstract
Aim: Immune checkpoint inhibitor (ICI) efficacy is undefined for melanoma brain metastases (MBM) with concurrent corticosteroid exposure. Materials & methods: We retrospectively evaluated patients with untreated MBM who received corticosteroids (≥1.5mg dexamethasone equivalent) within 30days of ICI. mRECIST criteria and Kaplan-Meier methods defined intracranial progression-free survival (iPFS). The lesion size-response association was evaluated with repeatedmeasures modeling. Results: A total of109 MBM were evaluated. The patientlevel intracranial response rate was 41%. Median iPFS was 2.3months and overall survival was 13.4months. Larger lesions were more likely to progress, with diameter >2.05cm most predictive of progression (OR: 18.9;95% CI: 2.6-139.5;p=0.004). There was no difference in iPFS with steroid exposure pre- versus post-ICI initiation. Conclusion: In the largestreported ICI+corticosteroid cohort, we identify sizedependent MBM response.
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