KEY TAKEAWAYS
- The study aimed to investigate the impact of combining SRS with nivo and ipi in patients with MBM.
- Researchers noticed superior LC with SRS combined with nivo and ipi; further investigation is ongoing.
Upfront dual checkpoint blockade with immune checkpoint inhibitors (ICI) has demonstrated efficacy in treating melanoma brain metastases (MBM) in asymptomatic patients. The potential added benefit of combining stereotactic radiosurgery (SRS) with dual checkpoint blockade remains unclear. Joseph D. Tang and his team aimed to assess clinical outcomes in MBM patients treated with ICI [nivolumab (nivo) and ipilimumab (ipi)], with and without SRS.
Researchers performed an inclusive analysis on 49 patients with 158 untreated MBM who received nivo and ipi between 2015 and 2022. Patient and tumor characteristics, encompassing age, Karnofsky Performance Status (KPS), symptom presence, cancer history, MBM burden, and therapy course, were meticulously recorded. Outcomes, including overall survival (OS), local control (LC), and distant intracranial control (DIC), were measured from the initiation of MBM-directed therapy. Time-to-event analysis was conducted using the Kaplan–Meier method.
About 25 patients with 74 MBM received ICI alone, while 24 patients with 84 MBM received concurrent SRS. The median follow-up duration was 24 months. No significant differences were observed in age (P= 0.96), KPS (P = 0.85), presence of symptoms (P = 0.79), prior MBM (P= 0.68), prior MBM-directed surgery (P= 0.96), SRS (P = 0.68), MBM size (P = 0.67), or MBM number (P = 0.94) between the ICI alone and SRS groups.
The SRS group exhibited a higher rate of completion for the nivo and ipi course (54% vs. 24%; P = 0.029). Additionally, the SRS group received prior immunotherapy more frequently than the ICI alone group (54% vs. 8.0%; P < 0.001). There were no significant differences in 1-year OS (72% vs. 71%, P = 0.20) and DIC (63% vs. 51%, P = 0.26) between the groups. However, the SRS group demonstrated a higher 1-year LC rate compared to the ICI alone group (92% vs. 64%; P = 0.002). Multivariate analysis revealed that LC was significantly improved with the combination therapy (AHR 0.38, P= 0.01).
The study concluded that patients receiving SRS with nivo and ipi exhibited superior LC without an elevated risk of toxicity or compromised completion of immunotherapy despite the SRS cohort having higher rates of prior immunotherapy. These findings emphasize the need for further prospective investigation into the combination of nivo and ipi with SRS for MBM.
No funding was provided for the study.
Source: https://link.springer.com/article/10.1007/s11060-023-04543-9#Abs1
Tang, J.D., Mills, M.N., Nakashima, J. et al. Clinical outcomes of melanoma brain metastases treated with nivolumab and ipilimumab alone versus nivolumab and ipilimumab with stereotactic radiosurgery. J Neurooncol 166, 431–440 (2024). https://doi.org/10.1007/s11060-023-04543-9
