Ipilimumab in Melanoma With Limited Brain Metastasis Treated With Stereotactic Radiosurgery

Abstract

Purpose/Objective(s)Ipilimumab, a human monoclonal antibody against Cytotoxic T-lymphocyte Associated Antigen 4(CTLA-4), has shown to improve the survival in patients with metastatic non-CNS melanoma. Its ability to cross the blood brain barrier or as a radiation sensitizer is not clear at this time. The purpose of this study was to investigate the efficacy of Ipilimumab in the treatment of metastatic melanoma with limited brain metastases treated with stereotactic radiosurgery (SRS).Materials/MethodsFrom January 2008- June 2011, 63 patients with limited brain metastases from melanoma were treated with SRS to a median dose of 20 Gy delivered to 50% isodose line (Range15-20 Gy). CTLA-4 inhibitors (ipilimumab/tremelimumab) were given to 27 patients. Local control (LC), diffuse progression free survival (PFS) and overall survival (OS) were assessed from the date of SRS procedure.ResultsThe median LC, diffuse PFS and OS for the entire group were 8.7, 4.3 and 5.7 months respectively. The cause of death was CNS progression in all but five patients. Salvage therapy was needed in 28 (44.5%) patients that included repeat SRS in 23 and Whole Brain Radiation Therapy (WBRT) in 7 patients. The median local PFS, diffuse PFS and OS were 8, 4.2 and 6.7 months respectively in patients who received Ipilimumab and 9, 5.3 and 5.2 respectively in patients who didn't receive Ipilimumab (p = ns). Intracranial hemorrhage was noted in 7 patients who received Ipilimumab compared to 10 in those who did not receive it (p = ns).ConclusionsAdministration of Ipilimumab does not appear to affect outcomes in patients with limited brain metastases who received SRS procedure. Purpose/Objective(s)Ipilimumab, a human monoclonal antibody against Cytotoxic T-lymphocyte Associated Antigen 4(CTLA-4), has shown to improve the survival in patients with metastatic non-CNS melanoma. Its ability to cross the blood brain barrier or as a radiation sensitizer is not clear at this time. The purpose of this study was to investigate the efficacy of Ipilimumab in the treatment of metastatic melanoma with limited brain metastases treated with stereotactic radiosurgery (SRS). Ipilimumab, a human monoclonal antibody against Cytotoxic T-lymphocyte Associated Antigen 4(CTLA-4), has shown to improve the survival in patients with metastatic non-CNS melanoma. Its ability to cross the blood brain barrier or as a radiation sensitizer is not clear at this time. The purpose of this study was to investigate the efficacy of Ipilimumab in the treatment of metastatic melanoma with limited brain metastases treated with stereotactic radiosurgery (SRS). Materials/MethodsFrom January 2008- June 2011, 63 patients with limited brain metastases from melanoma were treated with SRS to a median dose of 20 Gy delivered to 50% isodose line (Range15-20 Gy). CTLA-4 inhibitors (ipilimumab/tremelimumab) were given to 27 patients. Local control (LC), diffuse progression free survival (PFS) and overall survival (OS) were assessed from the date of SRS procedure. From January 2008- June 2011, 63 patients with limited brain metastases from melanoma were treated with SRS to a median dose of 20 Gy delivered to 50% isodose line (Range15-20 Gy). CTLA-4 inhibitors (ipilimumab/tremelimumab) were given to 27 patients. Local control (LC), diffuse progression free survival (PFS) and overall survival (OS) were assessed from the date of SRS procedure. ResultsThe median LC, diffuse PFS and OS for the entire group were 8.7, 4.3 and 5.7 months respectively. The cause of death was CNS progression in all but five patients. Salvage therapy was needed in 28 (44.5%) patients that included repeat SRS in 23 and Whole Brain Radiation Therapy (WBRT) in 7 patients. The median local PFS, diffuse PFS and OS were 8, 4.2 and 6.7 months respectively in patients who received Ipilimumab and 9, 5.3 and 5.2 respectively in patients who didn't receive Ipilimumab (p = ns). Intracranial hemorrhage was noted in 7 patients who received Ipilimumab compared to 10 in those who did not receive it (p = ns). The median LC, diffuse PFS and OS for the entire group were 8.7, 4.3 and 5.7 months respectively. The cause of death was CNS progression in all but five patients. Salvage therapy was needed in 28 (44.5%) patients that included repeat SRS in 23 and Whole Brain Radiation Therapy (WBRT) in 7 patients. The median local PFS, diffuse PFS and OS were 8, 4.2 and 6.7 months respectively in patients who received Ipilimumab and 9, 5.3 and 5.2 respectively in patients who didn't receive Ipilimumab (p = ns). Intracranial hemorrhage was noted in 7 patients who received Ipilimumab compared to 10 in those who did not receive it (p = ns). ConclusionsAdministration of Ipilimumab does not appear to affect outcomes in patients with limited brain metastases who received SRS procedure. Administration of Ipilimumab does not appear to affect outcomes in patients with limited brain metastases who received SRS procedure.