Home Forums Melanoma Diagnosis: Stage IV Interaction of IPI and Brain Mets: A Recent Study

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    We have had a couple of discussions over the last months on the Forum about the efficacy of the combination of SRS with ipi and the blood-brain barrier. I received my SRS on two brain mets in the category described here just before my third dose in my one and only course of ipi last fall. I found this interesting and hope some of you might too.

    Phase II trial of ipi monotherapy in melanoma patients with brain metastases.

    Authors: Lawrence, et al. Mass General, Boston. The Angeles Clinic, Santa Monica. Beth Israel, Boston. Vanderbilt, Nashville. Yale, New Haven. Loyola, Maywood, IL. Indiana University, Indianapolis. Dana-Farber Boston. Bristol-Meyers Squibb, NJ. University of Washington, Seattle.

    Ipilimumab, a human monoclonal antibody that blocks CTLA-4 has activity in advanced melanoma. This phase II trial attempted to assess ipi safety and activity in melanoma patients with brain mets. Patients had measurable brain mets with at least one lesion >0.5cm and/or 2 lesions greater than 0.3cm, and none greater than 3cm in diameter. Prior whole brain or stereotactic radiation to non-index lesions were allowed. Ipi 10mg/kg was given IV every 3 weeks for 4 doses. Responding or stable patients could receive maintenance ipi at 10mg/kg every 12 weeks. Total of 72 patients in two arms…arm B still ongoing. No association between brain edema or cerebral hemorrhage and objective response. Of 51 patients in Arm A, at week 12: 4/51 had a partial response, 5/51 had stable disease, with additional unconfirmed responses. Duration of responses ranged from 3 to 12+ months and duration of stable disease ranged from 1-7 months. CONCLUSION: Ipi has a similar level of activity in brain and non-CNS lesions. Analyses are ongoing and final data will be presented.


    Outcome with stereotactic radiosurgery (SRS) and ipilimumab (ipi) for malignant melanoma brain metastases.

    Authors: Shoukat, et al. Emory, Atlanta, GA.

    Retrospective analysis to determine if this combination is safe and improves overall survival. Patients with melanoma brain mets who underwent SRS b/w 1998-2010 (n=124) were compared to those who additionally got ipi (n=11). Median overall survival for the entire cohort was 6.9 months. Patients in the ipi group had an improved median overall survival of 28.3 months. CONCLUSION: Uses of SRS with ipi appears to be safe and associated with an impressive increase in median overall survival.

    Survival of melanoma patients with brain metastases treated with ipilimumab combined with stereotactic radiosurgery.

    Authors: Tazi, et al. Medical University of South Carolina, Charleston.

    Retrospective record review, we report the outcome of patients with stage IV melanoma with brain mets treated with ipi and SRS. Twelve of 30 patients treated with ipi had brain mets. Median age = 66 years. Group A = no brain mets. Group B = brain mets. 33% of both groups died as of last f/u. Median survivals from date of Stage IV for Group A = 29.1 months and for Group B = 32.9 months. Estimated 2 year survival rates from date of cycle 1 ipi administration for A = 58% and for B = 55%. CONCLUSION: Survival of patients with melanoma brain mets treated with ipi combined with SRS may be comparable to patients without brain mets.

    Catherine Poole

    This could be quite promising. Thanks for posting Frank.

    Celeste Morris

    Gee, Frank. The synopsis of each of those articles looks strikingly familiar. I write it there…Suddenly it’s here! For those of you interested in the full post regarding treatments for brain mets, not just the portion copied here, you can check my blog post on June 2, 2013. Chaoticallypreciselifeloveandmelanoma.blogspot.com – if you like. Hope it helps. C

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