title: Ipilimumab in patients with melanoma and brain metastases: an open-label, phase 2 trial.
abstract: BACKGROUND
  Brain metastases commonly develop in patients with melanoma and are a frequent cause of death of patients with this disease. Ipilimumab improves survival in patients with advanced melanoma. We aimed to investigate the safety and activity of this drug specifically in patients with brain metastases.
  
  
  METHODS
  Between July 31, 2008, and June 3, 2009, we enrolled patients with melanoma and brain metastases from ten US centres who were older than 16 years into two parallel cohorts. Patients in cohort A were neurologically asymptomatic and were not receiving corticosteroid treatment at study entry; those in cohort B were symptomatic and on a stable dose of corticosteroids. Patients were to receive four doses of 10 mg/kg intravenous ipilimumab, one every 3 weeks. Individuals who were clinically stable at week 24 were eligible to receive 10 mg/kg intravenous ipilimumab every 12 weeks. The primary endpoint was the proportion of patients with disease control, defined as complete response, partial response, or stable disease after 12 weeks, assessed with modified WHO criteria. Analyses of safety and efficacy included all treated patients. This trial is registered with ClinicalTrials.gov, number NCT00623766.
  
  
  RESULTS
  We enrolled 72 patients: 51 into cohort A and 21 into cohort B. After 12 weeks, nine patients in cohort A exhibited disease control (18%, 95% CI 8-31), as did one patient in cohort B (5%, 0·1-24). When the brain alone was assessed, 12 patients in cohort A (24%, 13-38) and two in cohort B (10%, 1-30) achieved disease control. We noted disease control outside of the brain in 14 patients (27%, 16-42) in cohort A and in one individual (5%, 0·1-24) in cohort B. The most common grade 3 adverse events in cohort A were diarrhoea (six patients [12%]) and fatigue (six [12%]); in cohort B, they were dehydration (two individuals [10%]), hyperglycaemia (two [10%]), and increased concentrations of serum aspartate aminotransferase (two [10%]). One patient in each cohort had grade 4 confusion. The most common grade 3 immune-related adverse events were diarrhoea (six patients [12%]) and rash (one [2%]) in cohort A, and rash (one individual [5%]) and increased concentrations of serum aspartate aminotransferase (two [10%]) in cohort B. One patient in cohort A died of drug-related complications of immune-related colitis.
  
  
  CONCLUSIONS
  Ipilimumab has activity in some patients with advanced melanoma and brain metastases, particularly when metastases are small and asymptomatic. The drug has no unexpected toxic effects in this population.
  
  
  BACKGROUND
  Bristol-Myers Squibb.
authors.affiliation: University of Washington, Seattle, WA 98109, USA. kmargoli@seattlecca.org
authors.forename: Kim
authors.initials: K
authors.lastname: Margolin
authors.forename: Marc S
authors.initials: MS
authors.lastname: Ernstoff
authors.forename: Omid
authors.initials: O
authors.lastname: Hamid
authors.forename: Donald
authors.initials: D
authors.lastname: Lawrence
authors.forename: David
authors.initials: D
authors.lastname: McDermott
authors.forename: Igor
authors.initials: I
authors.lastname: Puzanov
authors.forename: Jedd D
authors.initials: JD
authors.lastname: Wolchok
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Clark
authors.forename: Mario
authors.initials: M
authors.lastname: Sznol
authors.forename: Theodore F
authors.initials: TF
authors.lastname: Logan
authors.forename: Jon
authors.initials: J
authors.lastname: Richards
authors.forename: Tracy
authors.initials: T
authors.lastname: Michener
authors.forename: Agnes
authors.initials: A
authors.lastname: Balogh
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Heller
authors.forename: F Stephen
authors.initials: FS
authors.lastname: Hodi
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000556:secondary; D005260:Female; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab