Amaral, Teresa and Kiecker, Felix and Schaefer, Sarah and Stege, Henner and Kaehler, Katharina and Terheyden, Patrick and Gesierich, Anja and Gutzmer, Ralf and Haferkamp, Sebastian and Uttikal, Jochen and Berking, Carola and Rafei-Shamsabadi, David and Reinhardt, Lydia and Meier, Friedegund and Karoglan, Ante and Posch, Christian and Gambichler, Thilo and Pfoehler, Claudia and Thoms, Kai and Tietze, Julia and Debus, Dirk and Herbst, Rudolf and Emmert, Steffen and Loquai, Carmen and Hassel, Jessica C. and Meiss, Frank and Tueting, Thomas and Heinrich, Vanessa and Eigentler, Thomas and Garbe, Claus and Zimmer, Lisa (2020) Combined immunotherapy with nivolumab and ipilimumab with and without local therapy in patients with melanoma brain metastasis: a DeCOG* study in 380 patients. JOURNAL FOR IMMUNOTHERAPY OF CANCER, 8 (1): e000333. ISSN , 2051-1426
Full text not available from this repository. (Request a copy)Abstract
Background Nivolumab combined with ipilimumab have shown activity in melanoma brain metastasis (MBM). However, in most of the clinical trials investigating immunotherapy in this subgroup, patients with symptomatic MBM and/or prior local brain radiotherapy were excluded. We studied the efficacy of nivolumab plus ipilimumab alone or in combination with local therapies regardless of treatment line in patients with asymptomatic and symptomatic MBM. Methods Patients with MBM treated with nivolumab plus ipilimumab in 23 German Skin Cancer Centers between April 2015 and October 2018 were investigated. Overall survival (OS) was evaluated by Kaplan-Meier estimator and univariate and multivariate Cox proportional hazard analyses were performed to determine prognostic factors associated with OS. Results Three hundred and eighty patients were included in this study and 31% had symptomatic MBM (60/193 with data available) at the time of start nivolumab plus ipilimumab. The median follow-up was 18 months and the 2 years and 3 years OS rates were 41% and 30%, respectively. We identified the following independently significant prognostic factors for OS: elevated serum lactate dehydrogenase and protein S100B levels, number of MBM and Eastern Cooperative Oncology Group performance status. In these patients treated with checkpoint inhibition first-line or later, in the subgroup of patients with BRAFV600-mutated melanoma we found no differences in terms of OS when receiving first-line either BRAF and MEK inhibitors or nivolumab plus ipilimumab (p=0.085). In BRAF wild-type patients treated with nivolumab plus ipilimumab in first-line or later there was also no difference in OS (p=0.996). Local therapy with stereotactic radiosurgery or surgery led to an improvement in OS compared with not receiving local therapy (p=0.009), regardless of the timepoint of the local therapy. Receiving combined immunotherapy for MBM in first-line or at a later time point made no difference in terms of OS in this study population (p=0.119). Conclusion Immunotherapy with nivolumab plus ipilimumab, particularly in combination with stereotactic radiosurgery or surgery improves OS in asymptomatic and symptomatic MBM.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | STEREOTACTIC RADIOSURGERY; MALIGNANT-MELANOMA; OPEN-LABEL; SURVIVAL; RADIATION; OUTCOMES; MULTICENTER; DABRAFENIB; CANCER; MB; immunology; oncology; radiotherapy; surgery |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Dermatologie und Venerologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 07 Apr 2021 07:20 |
| Last Modified: | 07 Apr 2021 07:20 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45478 |
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