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Schoenfeld JD, Mahadevan A, Floyd SR, et al. Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review. J Immunother Cancer. 2015;3:50doi: 10.1186/s40425-015-0095-8.
Schoenfeld, J. D., Mahadevan, A., Floyd, S. R., Dyer, M. A., Catalano, P. J., Alexander, B. M., McDermott, D. F., & Kaplan, I. D. (2015). Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review. Journal for immunotherapy of cancer, 350. https://doi.org/10.1186/s40425-015-0095-8
Schoenfeld, Jonathan D, et al. "Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review." Journal for immunotherapy of cancer vol. 3 (2015): 50. doi: https://doi.org/10.1186/s40425-015-0095-8
Schoenfeld JD, Mahadevan A, Floyd SR, Dyer MA, Catalano PJ, Alexander BM, McDermott DF, Kaplan ID. Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review. J Immunother Cancer. 2015 Dec 15;3:50. doi: 10.1186/s40425-015-0095-8. eCollection 2015. PMID: 26672895; PMCID: PMC4678639.
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J Immunother Cancer. 2015 Dec 15;3:50. doi: 10.1186/s40425-015-0095-8. eCollection 2015.

Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review.

Journal for immunotherapy of cancer

Jonathan D Schoenfeld, Anand Mahadevan, Scott R Floyd, Michael A Dyer, Paul J Catalano, Brian M Alexander, David F McDermott, Irving D Kaplan

Affiliations

  1. Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave, DA L2-57, 02114 Boston, MA USA.
  2. Department of Radiation Oncology, Beth Israel Deaconess Hospital, Boston, MA USA.
  3. Department of Radiation Oncology, Beth Israel Deaconess Hospital, Boston, MA USA ; Department of Radiation Oncology, Duke Medical School, Durham, NC USA.
  4. Harvard Radiation Oncology Program, Boston, MA USA.
  5. Department of Medical Oncology, Boston, MA USA.

PMID: 26672895 PMCID: PMC4678639 DOI: 10.1186/s40425-015-0095-8

Abstract

BACKGROUND: Ipilimumab improves survival in metastatic melanoma patients. This population frequently develops brain metastases, which have been associated with poor survival and are often treated with radiation. Therefore, outcomes following ipilimumab and radiation are of interest, especially given case reports and animal studies suggest combined treatment may generate abscopal responses outside the radiation field.

FINDINGS: We reviewed sixteen consecutive melanoma patients who received 1 to 8 courses of radiation, with a sum total of 51, systematically evaluating abscopal responses by following the largest extra-cranial lesion. We also reviewed other series of patients treated with cranial radiation and ipilimumab. Our patients received between 1 and 8 courses of cranial radiation. Four patients received radiation concurrently with ipilimumab. Median survival was 14 months, and 17 months in patients initially treated with SRS. Interestingly, after radiotherapy, there was a 2.8-fold increased likelihood that the rate of extra-cranial index lesion response improved that didn't reach statistical significance (p = 0.07); this was more pronounced when ipilimumab was administered within three months of radiation (p < 0.01).

CONCLUSION: Our experience and review of recently published series suggest ipilimumab and cranial radiation is well tolerated and can result in prolonged survival. Timing of ipilimumab administration in relation to radiation may impact outcomes. Additionally, our results demonstrate a trend for favorable systemic response following radiotherapy worthy of further evaluation in studies powered to detect potential synergies between radiation and immunotherapy.

Keywords: Abscopal effect; Brain metastases; Immunotherapy; Ipilimumab; Melanoma; Radiation; Stereotactic radiosurgery

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