title: Ipilimumab in melanoma with limited brain metastases treated with stereotactic radiosurgery.
abstract: The anti-cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) monoclonal antibody ipilimumab has been shown to improve survival in patients with metastatic non-CNS melanoma. The purpose of this study was to investigate the efficacy of CTLA-4 inhibitors in the treatment of metastatic melanoma with limited brain metastases treated with stereotactic radiosurgery (SRS). Between January 2008 and June 2011, 58 patients with limited brain metastases from melanoma were treated with SRS with a median dose of 20 Gy delivered to the 50% isodose line (range, 15-20 Gy). In 25 patients, ipilimumab was administered intravenously at a dose of 3 mg/kg over 90 min every 3 weeks for a median of four doses (range, 1-8). Local control (LC), freedom from new brain metastases, and overall survival (OS) were assessed from the date of the SRS procedure. The median LC, freedom from new brain metastases, and OS for the entire group were 8.7, 4.3, and 5.9 months, respectively. The cause of death was CNS progression in all but eight patients. Six-month LC, freedom from new brain metastases, and OS were 65, 35, and 56%, respectively, for those who received ipilimumab and 63, 47, and 46% for those who did not (P=NS). Intracranial hemorrhage was noted in seven patients who received ipilimumab compared with 10 patients who received SRS alone (P=NS). In this retrospective study, administration of ipilimumab neither increased toxicity nor improved intracerebral disease control in patients with limited brain metastases who received SRS.
authors: Department of Radiation Oncology, New York University Langone Medical Center, New York, New York 10016, USA.
authors: Maya
authors: M
authors: Mathew
authors: Moses
authors: M
authors: Tam
authors: Patrick A
authors: PA
authors: Ott
authors: Anna C
authors: AC
authors: Pavlick
authors: Stephen C
authors: SC
authors: Rush
authors: Bernadine R
authors: BR
authors: Donahue
authors: John G
authors: JG
authors: Golfinos
authors: Erik C
authors: EC
authors: Parker
authors: Paul P
authors: PP
authors: Huang
authors: Ashwatha
authors: A
authors: Narayana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*
chemical_list: D000911:Antibodies, Monoclonal; D000074324:Ipilimumab