Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review.
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 articleSubject
Abscopal effectBrain metastases
Immunotherapy
Ipilimumab
Melanoma
Radiation
Stereotactic radiosurgery
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https://hdl.handle.net/10161/15935Published Version (Please cite this version)
10.1186/s40425-015-0095-8Publication 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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Show full item recordScholars@Duke
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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