Central Nervous System

PV QA 2 - Poster Viewing Q&A 2

MO_4_2535 - Safety and clinical outcomes of ipilimumab and nivolumab plus concurrent stereotactic radiosurgery for brain metastases

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Safety and clinical outcomes of ipilimumab and nivolumab plus concurrent stereotactic radiosurgery for brain metastases
C. B. Johnson1, M. A. Postow1, P. Chapman1, J. D. Wolchok1, C. W. Brennan2, V. S. Tabar3, T. A. Chan1, Y. Yamada1, T. J. Yang1, and K. Beal1; 1Memorial Sloan Kettering Cancer Center, New York, NY, 2Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 3Multidisciplinary Skull Base and Pituitary Center at Memorial Sloan Kettering Cancer Center, New York, NY

Purpose/Objective(s): Combining single agent immune checkpoint inhibition (ICI) with intracranial stereotactic radiosurgery (SRS) has shown potential clinical benefit with an acceptable adverse event profile for cancer patients with brain metastases. Whether dual ICI combined with brain SRS will demonstrate similar results is not yet known. In this retrospective analysis we assessed safety and clinical outcomes in patients with brain metastases (BMs) treated with concurrent ipilimumab plus nivolumab (ipi/nivo) and stereotactic radiosurgery or stereotactic radiotherapy (SRS/SRT).

Materials/Methods: We analyzed a single institutional database to identify all patients treated with dual ipi/nivo and concurrent SRS/SRT, which was defined as RT given between 4 months after and 1 month before ipi/nivo. Adverse events were reported using CTCAE v5.0. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier method dated from start of radiation.

Results: We identified 37 patients with a total of 116 BMs treated with concurrent ipi/nivo (median 2 doses) and SRS/SRT between May 2013 and December 2017. Melanoma (23 patients; 11 BRAF+) and lung (10 patients) were the most common primary tumor types. Median lesion size was 1.1cm (range 0.2 to 3.6cm), median number of lesions treated was 2 (range 1-7) and 2100cGy was the median radiation dose. After a median follow-up time of 15 months, only 1 neurological grade 3 or higher toxicity (grade 3 radiation necrosis) and 3 grade 2 toxicities were observed. Of the 116 treated lesions, recurrence was observed in 10 lesions (between 1.5 and 16 months after RT), with 1-year local PFS of 91%. For the overall population, median intracranial PFS was 8 months, and median OS was 21 months. For the 23 melanoma patients, median intracranial PFS was 2.8 months and median OS was 21 months, with a trend toward worse survival for the BRAF+ cohort (median OS = 10.4 months, p = 0.15).

Conclusion: Combining ipi/nivo with concurrent SRS/SRT for brain metastases is well-tolerated and demonstrates promising clinical activity. Prospective evaluation of this combination is warranted.

Author Disclosure: C.B. Johnson: None. M.A. Postow: Fees; BMS. P. Chapman: Consultant; Daiichi, Roche and Genetech. Advisor; Merck. J.D. Wolchok: grants from Bristol Myers Squibb, grants from MedImmune, grants from Genentech, grants from Merck, during the conduct of the study; other from Bristol Myers Squibb, other from Merck, other from MedImmune, outside the submitted work.; See other. V.S. Tabar: None. T.A. Chan: Vice Chair; Memorial Sloan Kettering. Y. Yamada: Speaker's Bureau; BrainLab, Varian Medical Systems, Institute for Medical Education. T. Yang: None. K. Beal: Stock; Magnolia Medical Technology (MMT).

Send Email for Christopher Johnson


Assets

MO_4_2535 - Safety and clinical outcomes of ipilimumab and nivolumab plus concurrent stereotactic radiosurgery for brain metastases



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Safety and clinical outcomes of ipilimumab and nivolumab plus concurrent stereotactic radiosurgery for brain metastases