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01-10-2018 | Clinical Study

Immune checkpoint inhibitors and radiosurgery for newly diagnosed melanoma brain metastases

Authors: Tyler P. Robin, Robert E. Breeze, Derek E. Smith, Chad G. Rusthoven, Karl D. Lewis, Rene Gonzalez, Amanda Brill, Robin Saiki, Kelly Stuhr, Laurie E. Gaspar, Sana D. Karam, David Raben, Brian D. Kavanagh, Sameer K. Nath, Arthur K. Liu

Published in: Journal of Neuro-Oncology | Issue 1/2018

Abstract

Introduction

Brain metastases are common in metastatic melanoma and radiosurgery is often utilized for local control. Immune checkpoint inhibitors (CPIs) play a central role in contemporary melanoma management; however, there is limited data exploring outcomes and potential toxicities for patients treated with CPIs and radiosurgery.

Methods

We retrospectively identified all consecutive cases of newly diagnosed melanoma brain metastases (MBM) treated with Gamma Knife radiosurgery at a single institution between 2012 and 2017, and included only patients that initiated CPIs within 8 weeks before or after radiosurgery.

Results

Thirty-eight patients were included with a median follow-up of 31.6 months. Two-year local control was 92%. Median time to out-of-field CNS and extra-CNS progression were 8.4 and 7.9 months, respectively. Median progression-free survival (PFS) was 3.4 months and median overall survival (OS) was not reached (NR). Twenty-five patients (66%) received anti-CTLA4 and 13 patients (34%) received anti-PD-1+/-anti-CTLA4. Compared with anti-CTLA4, patients that received anti-PD-1+/-anti-CTLA4 had significant improvements in time to out-of-field CNS progression (p = 0.049), extra-CNS progression (p = 0.015), and PFS (p = 0.043), with median time to out-of-field CNS progression of NR vs. 3.1 months, median time to extra-CNS progression of NR vs. 4.4 months, and median PFS of 20.3 vs. 2.4 months. Six patients (16%) developed grade ≥ 2 CNS toxicities (grade 2: 3, grade 3: 3, grade 4/5: 0).

Conclusions

Excellent outcomes were observed in patients that initiated CPIs within 8 weeks of undergoing radiosurgery for newly diagnosed MBM. There appears to be an advantage to anti-PD-1 or combination therapy compared to anti-CTLA4.

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Title: Immune checkpoint inhibitors and radiosurgery for newly diagnosed melanoma brain metastases
Authors: Tyler P. Robin
Robert E. Breeze
Derek E. Smith
Chad G. Rusthoven
Karl D. Lewis
Rene Gonzalez
Amanda Brill
Robin Saiki
Kelly Stuhr
Laurie E. Gaspar
Sana D. Karam
David Raben
Brian D. Kavanagh
Sameer K. Nath
Arthur K. Liu
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 1/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-2930-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Immune checkpoint inhibitors and radiosurgery for newly diagnosed melanoma brain metastases

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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