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

dc.contributor.author Schoenfeld, Jonathan D
dc.contributor.author Mahadevan, Anand
dc.contributor.author Floyd, Scott R
dc.contributor.author Dyer, Michael A
dc.contributor.author Catalano, Paul J
dc.contributor.author Alexander, Brian M
dc.contributor.author McDermott, David F
dc.contributor.author Kaplan, Irving D
dc.coverage.spatial England
dc.date.accessioned 2018-01-01T18:21:37Z
dc.date.available 2018-01-01T18:21:37Z
dc.date.issued 2015
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26672895
dc.identifier 95
dc.identifier.issn 2051-1426
dc.identifier.uri https://hdl.handle.net/10161/15935
dc.description.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.
dc.language eng
dc.publisher BMJ
dc.relation.ispartof J Immunother Cancer
dc.relation.isversionof 10.1186/s40425-015-0095-8
dc.subject Abscopal effect
dc.subject Brain metastases
dc.subject Immunotherapy
dc.subject Ipilimumab
dc.subject Melanoma
dc.subject Radiation
dc.subject Stereotactic radiosurgery
dc.title Ipilmumab and cranial radiation in metastatic melanoma patients: a case series and review.
dc.type Journal article
duke.contributor.id Floyd, Scott R|0687720
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26672895
pubs.begin-page 50
pubs.organisational-group Basic Science Departments
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Pharmacology & Cancer Biology
pubs.organisational-group Radiation Oncology
pubs.organisational-group School of Medicine
pubs.organisational-group Temp group - logins allowed
pubs.publication-status Published online
pubs.volume 3


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