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Immune checkpoint inhibitors and stereotactic radiosurgery (SRS) in melanoma brain metastases.

2018; Lippincott Williams & Wilkins; Volume: 36; Issue: 15_suppl Linguagem: Inglês

10.1200/jco.2018.36.15_suppl.e21523

1527-7755

Charlotte Fenioux, I. Troussier, Jean‐Jacques Mazeron, Charles Canova, Philippe Saïag, Magali Fort, Jean‐Philippe Spano, Antoine Kourilsky, Ioannis Lamproglou, P. Maingon, Charles A. Valéry,

Nanoplatforms for cancer theranostics

e21523 Background: Major advances have been made in management of metastatic melanoma with immune checkpoint therapy (ICT) such as anti-CTLA4 and anti-PD1 therapies. However, data on the use of ICT in combination with brain radiation therapy is limited. In this study, we reported toxicities and efficiency outcomes of patients undergoing concurrent administration of ICT and Gamma-knife radiosurgery. Methods: From an institutional database, we identified, all consecutive patients with melanoma brain metastasis, treated with Gamma Knife radiosurgery, who receiving concurrent ICT with anti-CTLA4 or anti-PD1 within the 12 weeks of SRS procedure. Results: From January 2014 to December 2016, 62 patients with 296 lesions were included, and 55 patients (88%) had ongoing ICT at the time of irradiation. Median follow-up time was 18 months (13-22). Minimal median dose at 50% reference isodose was 18 Gy, with a median tumor volume of 0.22 cm3. Median healthy tissue receiving 12 Gy per lesion was 1.04 cm3. 10 patients (16,1%) had adverse events of all grade following irradiation, with 5 grade > = 3, and one patient had radionecrosis. The 1 year control rate per lesion irradiated was 90%. Thirty patients (48%) developed distant brain metastases after a median time of 3.2 months following GK procedure. At the time of analysis, 35 patients had died. Median OS was 14 months from the date of radiation treatment. Median OS in subgroup treated with Ipilimumab (n = 35), Nivolumab (n = 15), multiples immunotherapy (n = 8) were respectively: 13 months, 14 months, 13.5 months; and was not reached for the Pembrolizumab subgroup (n = 12). In univariate analysis, predictive factors of OS were: DS-GPA score ≥3 (p = 0,022), number of lesions irradiated (p = 0,0011), localization in the brainstem (p = 0,013), total volume (p = 0.01), previous irradiation (p = 0.05). Conclusions: Association of Gamma-knife radiosurgery and immune checkpoint inhibitor in melanoma brain metastasis is safe and shows favorable outcomes in this population excluded from most trials.