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Journal of Neuro-Oncology

, Volume 121, Issue 1, pp 159–165 | Cite as

Ipilimumab and whole brain radiation therapy for melanoma brain metastases

  • Naamit K. Gerber
  • Robert J. Young
  • Christopher A. Barker
  • Jedd D. Wolchok
  • Timothy A. Chan
  • Yoshiya Yamada
  • Leigh Friguglietti
  • Kathryn Beal
Clinical Study

Abstract

Brain metastases (BM) frequently develop in patients with melanoma and are associated with a poor prognosis. Whole brain radiation therapy (WBRT) is a standard intervention for intracranial disease, particularly in patients with multiple BM. Ipilimumab improves survival in patients with advanced melanoma. The purpose of this study is to investigate the safety and efficacy of concurrent WBRT and ipilimumab. A retrospective analysis was conducted of 13 consecutive patients treated with WBRT within 30 days of ipilimumab administration. Radiographic response, as measured by serial magnetic resonance imaging scans post-treatment, was graded by modified World Health Organization (mWHO) and immune-related response criteria (irRC) in the 9 patients with follow-up imaging. Treatment-related toxicity was prospectively assessed during treatment. Four of nine patients (44 %) experienced partial response or stable central nervous system (CNS) disease as measured by mWHO criteria. This number increased to 5 patients (56 %) when irRC criteria were used. Rates of treatment-related neurologic toxicity were low with only one patient experiencing grade 3–4 neurologic toxicity. There was a high rate of intratumoral hemorrhage in this patient population, with 10 of 10 patients with post-treatment imaging demonstrating new or increased intratumoral bleeding after WBRT. This retrospective study demonstrates that the primary pattern of CNS response to WBRT and ipilimumab is stable disease and not regression of BM. Furthermore, while the combination of WBRT and ipilimumab may offer promising efficacy, prospective studies are needed to further assess efficacy and toxicity.

Keywords

Melanoma Brain metastases Ipilimumab Immunotherapy Whole brain radiotherapy 

Notes

Acknowledgements

The authors would like to thank Lawrence A. Herman for his editorial assistance.

Conflict of interest

Dr. Wolchok is a paid consultant for and receives research funding from Bristol-Myers Squibb.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Naamit K. Gerber
    • 1
  • Robert J. Young
    • 2
  • Christopher A. Barker
    • 1
  • Jedd D. Wolchok
    • 3
    • 4
  • Timothy A. Chan
    • 1
  • Yoshiya Yamada
    • 1
  • Leigh Friguglietti
    • 1
  • Kathryn Beal
    • 1
  1. 1.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Medicine and Ludwig CenterMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Weill Cornell Medical CollegeNew YorkUSA

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