Ipilimumab and radiation therapy for melanoma brain metastases

Abstract

Ipilimumab, an antibody that enhances T-cell activation, may augment immunogenicity of tumor cells that are injured by radiation therapy. We hypothesized that patients with melanoma brain metastasis treated with both ipilimumab and radiotherapy would have improved overall survival, and that the sequence of treatments may affect disease control in the brain. We analyzed the clinical and radiographic records of melanoma patients with brain metastases who were treated with whole brain radiation therapy or stereotactic radiosurgery between 2005 and 2012. The hazard ratios for survival were estimated to assess outcomes as a function of ipilimumab use and radiation type. Seventy patients were identified, 33 of whom received ipilimumab and 37 who did not. The patients who received ipilimumab had a censored median survival of 18.3 months (95% confidence interval 8.1-25.5), compared with 5.3 months (95% confidence interval 4.0-7.6) for patients who did not receive ipilimumab. Ipilimumab and stereotactic radiosurgery were each significant predictors of improved overall survival (hazard ratio = 0.43 and 0.45, with P = 0.005 and 0.008, respectively). Four of 10 evaluable patients (40.0%) who received ipilimumab prior to radiotherapy demonstrated a partial response to radiotherapy, compared with two of 22 evaluable patients (9.1%) who did not receive ipilimumab. Ipilimumab is associated with a significantly reduced risk of death in patients with melanoma brain metastases who underwent radiotherapy, and this finding supports the need for multimodality therapy to optimize patient outcomes. Prospective studies are needed and are underway.

Keywords: Brain metastases; immunotherapy; ipilimumab; melanoma; stereotactic radiosurgery.

Figure 1

Censored overall survival of all patients by ipilimumab treatment. Treatment with ipilimumab was significantly associated with improved survival (HR = 0.43, P = 0.005). HR, hazard ratio.

Figure 2

Censored overall survival of patients for each type of radiation therapy by ipilimumab treatment. (A) WBRT: treatment with ipilimumab was not associated with survival in the subset of patients who underwent WBRT (HR = 0.56, P = 0.15); (B) SRS: treatment with ipilimumab was significantly associated with improved survival in the subset of patients who underwent SRS (HR = 0.31, P = 0.009). WBRT, whole brain radiation therapy; HR, hazard ratio; SRS, stereotactic radiosurgery.