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

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Date
2015
Authors
Schoenfeld, Jonathan D
Mahadevan, Anand
Floyd, Scott R
Dyer, Michael A
Catalano, Paul J
Alexander, Brian M
McDermott, David F
Kaplan, Irving D
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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.
Type
Journal article
Subject
Abscopal effect
Brain metastases
Immunotherapy
Ipilimumab
Melanoma
Radiation
Stereotactic radiosurgery
Permalink
https://hdl.handle.net/10161/15935
Published Version (Please cite this version)
10.1186/s40425-015-0095-8
Publication Info
Schoenfeld, Jonathan D; Mahadevan, Anand; Floyd, Scott R; Dyer, Michael A; Catalano, Paul J; Alexander, Brian M; ... Kaplan, Irving D (2015). Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review. J Immunother Cancer, 3. pp. 50. 10.1186/s40425-015-0095-8. Retrieved from https://hdl.handle.net/10161/15935.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Floyd

Scott Richard Floyd

Gary Hock and Lyn Proctor Associate Professor of Radiation Oncology
Diseases of the brain carry particular morbidity and mortality, given the fundamental function of the brain for human life and quality of life. Disease of the brain are also particularly difficult to study, given the complexity of the brain. Model systems that capture this complexity, but still allow for experiments to test therapies and mechanisms of disease are badly needed.  We have developed an experimental model system that uses slices made from rat and mouse brains to create a test
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