title: Ipilimumab and Stereotactic Radiosurgery Versus Stereotactic Radiosurgery Alone for Newly Diagnosed Melanoma Brain Metastases.
abstract: BACKGROUND
  We compared the safety and efficacy of ipilimumab and stereotactic radiosurgery (SRS) to SRS alone for newly diagnosed melanoma brain metastases (MBM).
  
  
  METHODS
  We reviewed records of newly diagnosed MBM patients treated with SRS from 2009 to 2013. The primary endpoint of overall survival (OS), and secondary endpoints of local control, distant intracranial failure, and radiation necrosis were compared using Kaplan-Meier method. Univariate and multivariate analysis were performed using the Cox proportional hazards method.
  
  
  RESULTS
  Fifty-four consecutive MBM patients were identified, with 20 (37.0%) receiving ipilimumab within 4 months of SRS. Ipilimumab-treated and non-ipilimumab-treated patients had similar baseline characteristics. No difference in symptomatic radiation necrosis or hemorrhage was identified between cohorts. Compared with patients in the nonipilimumab group, 1 year local control (71.4% vs. 92.3%, P=0.40) and intracranial control (12.7% vs. 29.1%, P=0.59) were also statistically similar. The ipilimumab cohort also had no difference in 1-year OS (37.1% vs. 38.5%, P=0.84). Patients administered ipilimumab within 14 days of SRS had higher 1-year (42.9%) and 2-year OS (42.9%) relative to ipilimumab delivered >14 days (33.8%, 16.9%) and SRS alone (38.5%, 25.7%) but these difference were not statistically significant. Univariate analysis and multivariate analysis both confirmed single brain metastasis, controlled primary, and active systemic disease as predictors for OS.
  
  
  CONCLUSIONS
  Use of ipilimumab within 4 months of SRS seems to be safe, with no increase in radiation necrosis or hemorrhage; however, our retrospective institutional experience with this treatment regimen was not associated with improved outcomes.
authors.affiliation: Departments of *Radiation Oncology §Surgery, Division of Surgical Oncology #Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute Departments of †Internal Medicine ∥Hematology and Medical Oncology ¶Radiology, Emory University ‡Emory University School of Medicine, Atlanta, GA.
authors.forename: Kirtesh R
authors.initials: KR
authors.lastname: Patel
authors.forename: Sana
authors.initials: S
authors.lastname: Shoukat
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Oliver
authors.forename: Mudit
authors.initials: M
authors.lastname: Chowdhary
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.forename: David H
authors.initials: DH
authors.lastname: Lawson
authors.forename: Faisal
authors.initials: F
authors.lastname: Khosa
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D012878:Skin Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab