Improved time to disease progression in the brain in patients with melanoma brain metastases treated with concurrent delivery of radiosurgery and ipilimumab

Tijana Skrepnik, Srinath Sundararajan, Haiyan Cui, Baldassarre Stea

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: To identify the optimal sequencing and timing of immunotherapy (IT) and stereotactic radiosurgery (SRS) for melanoma brain metastases (MBMs). Methods: The elapsed days between IT and SRS were correlated with local control (LC), regional brain control (RBC), time to CNS progression (TTPCNS), overall survival (OS), and radiation necrosis (RN). Logistic regression and Cox proportional models were used for statistical analysis. Results: Twenty-five patients with 58 MBMs underwent SRS and IT. Median follow-up was 22.7 mo (3.1–77.9 mo). A median of 2 SRS treatments of 21 Gy (range 16–24 Gy) and 4 cycles of Ipilimumab were delivered. SRS was delivered Before, After or Concurrently with IT in 9, 5, and 11 patients, respectively; 8/25 received SRS ≤30 d of IT and 17/25 were >30 d of IT. Median OS was 35.8 mo, 1- and 2-y OS was 83% and 64%, respectively, and LC was 94.8%. By timing, RBC and TTPCNS were significantly improved when SRS was delivered ≤30 d of IT (75% vs 23.5%, p = 0.03 and median not reached vs 5.7 mo, p = 0.02, respectively). By groups, Concurrent delivery improved TTPCNS (p = 0.04). The rate of RN was 20.7% (12/58 lesions) and RN was associated with improved OS (HR 0.21, p = 0.01). Conclusions: High OS was found for MBM treated with SRS and IT compared to historical reports. A significant association for improved RBC and TTPCNS was found when SRS was delivered concurrently and within 30 d of IT. Occurrence of RN was higher than SRS alone series but significantly associated with improved OS.

Original languageEnglish (US)
Article numbere1283461
JournalOncoImmunology
Volume6
Issue number3
DOIs
StatePublished - Mar 4 2017

Fingerprint

Radiosurgery
Disease Progression
Melanoma
Immunotherapy
Neoplasm Metastasis
Brain
Survival
Necrosis
Radiation
ipilimumab
Proportional Hazards Models
Logistic Models

Keywords

  • Brain metastases
  • immunotherapy
  • melanoma
  • radiosurgery
  • timing

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Oncology

Cite this

Improved time to disease progression in the brain in patients with melanoma brain metastases treated with concurrent delivery of radiosurgery and ipilimumab. / Skrepnik, Tijana; Sundararajan, Srinath; Cui, Haiyan; Stea, Baldassarre.

In: OncoImmunology, Vol. 6, No. 3, e1283461, 04.03.2017.

Research output: Contribution to journalArticle

@article{71423df678ae401c922be0c456ad4584,
title = "Improved time to disease progression in the brain in patients with melanoma brain metastases treated with concurrent delivery of radiosurgery and ipilimumab",
abstract = "Background: To identify the optimal sequencing and timing of immunotherapy (IT) and stereotactic radiosurgery (SRS) for melanoma brain metastases (MBMs). Methods: The elapsed days between IT and SRS were correlated with local control (LC), regional brain control (RBC), time to CNS progression (TTPCNS), overall survival (OS), and radiation necrosis (RN). Logistic regression and Cox proportional models were used for statistical analysis. Results: Twenty-five patients with 58 MBMs underwent SRS and IT. Median follow-up was 22.7 mo (3.1–77.9 mo). A median of 2 SRS treatments of 21 Gy (range 16–24 Gy) and 4 cycles of Ipilimumab were delivered. SRS was delivered Before, After or Concurrently with IT in 9, 5, and 11 patients, respectively; 8/25 received SRS ≤30 d of IT and 17/25 were >30 d of IT. Median OS was 35.8 mo, 1- and 2-y OS was 83{\%} and 64{\%}, respectively, and LC was 94.8{\%}. By timing, RBC and TTPCNS were significantly improved when SRS was delivered ≤30 d of IT (75{\%} vs 23.5{\%}, p = 0.03 and median not reached vs 5.7 mo, p = 0.02, respectively). By groups, Concurrent delivery improved TTPCNS (p = 0.04). The rate of RN was 20.7{\%} (12/58 lesions) and RN was associated with improved OS (HR 0.21, p = 0.01). Conclusions: High OS was found for MBM treated with SRS and IT compared to historical reports. A significant association for improved RBC and TTPCNS was found when SRS was delivered concurrently and within 30 d of IT. Occurrence of RN was higher than SRS alone series but significantly associated with improved OS.",
keywords = "Brain metastases, immunotherapy, melanoma, radiosurgery, timing",
author = "Tijana Skrepnik and Srinath Sundararajan and Haiyan Cui and Baldassarre Stea",
year = "2017",
month = "3",
day = "4",
doi = "10.1080/2162402X.2017.1283461",
language = "English (US)",
volume = "6",
journal = "OncoImmunology",
issn = "2162-4011",
publisher = "Landes Bioscience",
number = "3",

}

TY - JOUR

T1 - Improved time to disease progression in the brain in patients with melanoma brain metastases treated with concurrent delivery of radiosurgery and ipilimumab

AU - Skrepnik, Tijana

AU - Sundararajan, Srinath

AU - Cui, Haiyan

AU - Stea, Baldassarre

PY - 2017/3/4

Y1 - 2017/3/4

N2 - Background: To identify the optimal sequencing and timing of immunotherapy (IT) and stereotactic radiosurgery (SRS) for melanoma brain metastases (MBMs). Methods: The elapsed days between IT and SRS were correlated with local control (LC), regional brain control (RBC), time to CNS progression (TTPCNS), overall survival (OS), and radiation necrosis (RN). Logistic regression and Cox proportional models were used for statistical analysis. Results: Twenty-five patients with 58 MBMs underwent SRS and IT. Median follow-up was 22.7 mo (3.1–77.9 mo). A median of 2 SRS treatments of 21 Gy (range 16–24 Gy) and 4 cycles of Ipilimumab were delivered. SRS was delivered Before, After or Concurrently with IT in 9, 5, and 11 patients, respectively; 8/25 received SRS ≤30 d of IT and 17/25 were >30 d of IT. Median OS was 35.8 mo, 1- and 2-y OS was 83% and 64%, respectively, and LC was 94.8%. By timing, RBC and TTPCNS were significantly improved when SRS was delivered ≤30 d of IT (75% vs 23.5%, p = 0.03 and median not reached vs 5.7 mo, p = 0.02, respectively). By groups, Concurrent delivery improved TTPCNS (p = 0.04). The rate of RN was 20.7% (12/58 lesions) and RN was associated with improved OS (HR 0.21, p = 0.01). Conclusions: High OS was found for MBM treated with SRS and IT compared to historical reports. A significant association for improved RBC and TTPCNS was found when SRS was delivered concurrently and within 30 d of IT. Occurrence of RN was higher than SRS alone series but significantly associated with improved OS.

AB - Background: To identify the optimal sequencing and timing of immunotherapy (IT) and stereotactic radiosurgery (SRS) for melanoma brain metastases (MBMs). Methods: The elapsed days between IT and SRS were correlated with local control (LC), regional brain control (RBC), time to CNS progression (TTPCNS), overall survival (OS), and radiation necrosis (RN). Logistic regression and Cox proportional models were used for statistical analysis. Results: Twenty-five patients with 58 MBMs underwent SRS and IT. Median follow-up was 22.7 mo (3.1–77.9 mo). A median of 2 SRS treatments of 21 Gy (range 16–24 Gy) and 4 cycles of Ipilimumab were delivered. SRS was delivered Before, After or Concurrently with IT in 9, 5, and 11 patients, respectively; 8/25 received SRS ≤30 d of IT and 17/25 were >30 d of IT. Median OS was 35.8 mo, 1- and 2-y OS was 83% and 64%, respectively, and LC was 94.8%. By timing, RBC and TTPCNS were significantly improved when SRS was delivered ≤30 d of IT (75% vs 23.5%, p = 0.03 and median not reached vs 5.7 mo, p = 0.02, respectively). By groups, Concurrent delivery improved TTPCNS (p = 0.04). The rate of RN was 20.7% (12/58 lesions) and RN was associated with improved OS (HR 0.21, p = 0.01). Conclusions: High OS was found for MBM treated with SRS and IT compared to historical reports. A significant association for improved RBC and TTPCNS was found when SRS was delivered concurrently and within 30 d of IT. Occurrence of RN was higher than SRS alone series but significantly associated with improved OS.

KW - Brain metastases

KW - immunotherapy

KW - melanoma

KW - radiosurgery

KW - timing

UR - http://www.scopus.com/inward/record.url?scp=85014473454&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014473454&partnerID=8YFLogxK

U2 - 10.1080/2162402X.2017.1283461

DO - 10.1080/2162402X.2017.1283461

M3 - Article

AN - SCOPUS:85014473454

VL - 6

JO - OncoImmunology

JF - OncoImmunology

SN - 2162-4011

IS - 3

M1 - e1283461

ER -