Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review

Journal for ImmunoTherapy of Cancer

Irving D. Kaplan²  David F. McDermott³  Brian M. Alexander⁴  Paul J. Catalano⁴  Michael A. Dyer⁵  Scott R. Floyd¹  Anand Mahadevan²  Jonathan D. Schoenfeld⁴ 

[1] Department of Radiation Oncology, Duke Medical School, Durham, NC, USA;Department of Radiation Oncology, Beth Israel Deaconess Hospital, Boston, MA, USA;Department of Medical Oncology, Boston, MA, USA;Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave, DA L2-57, Boston, 02114, MA, USA;Harvard Radiation Oncology Program, Boston, MA, USA

关键词: Stereotactic radiosurgery;    Brain metastases;    Abscopal effect;    Radiation;    Immunotherapy;    Ipilimumab;    Melanoma;   

Others  :  1234894
DOI  :  10.1186/s40425-015-0095-8

 received in 2015-09-03, accepted in 2015-10-14,  发布年份 2015

【 摘 要 】

Background

Ipilimumab improves survival in metastatic melanoma patients. This population frequently develops brain metastases, which have been associated with poor survival and are often treated with radiation. Therefore, outcomes following ipilimumab and radiation are of interest, especially given case reports and animal studies suggest combined treatment may generate abscopal responses outside the radiation field.

Findings

We reviewed sixteen consecutive melanoma patients who received 1 to 8 courses of radiation, with a sum total of 51, systematically evaluating abscopal responses by following the largest extra-cranial lesion. We also reviewed other series of patients treated with cranial radiation and ipilimumab.

Our patients received between 1 and 8 courses of cranial radiation. Four patients received radiation concurrently with ipilimumab. Median survival was 14 months, and 17 months in patients initially treated with SRS. Interestingly, after radiotherapy, there was a 2.8-fold increased likelihood that the rate of extra-cranial index lesion response improved that didn’t reach statistical significance (p = 0.07); this was more pronounced when ipilimumab was administered within three months of radiation (p < 0.01).

Conclusion

Our experience and review of recently published series suggest ipilimumab and cranial radiation is well tolerated and can result in prolonged survival. Timing of ipilimumab administration in relation to radiation may impact outcomes. Additionally, our results demonstrate a trend for favorable systemic response following radiotherapy worthy of further evaluation in studies powered to detect potential synergies between radiation and immunotherapy.

【 授权许可】

   
2015 Schoenfeld et al.

【 图 表 】

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