MMAP-09 EFFICACY OF IPILIMUMAB-NIVOLUMAB IN PATIENTS WITH MULTIPLE MELANOMA BRAIN METASTASES

Abstract Immunotherapy with ipilimumab (ipi) and nivolumab (nivo) has shown impressive response rates in patients with melanoma brain metastases (MBM) with a clinical outcome comparable to patients without MBM. However, within clinical trials most patients had only single brain metastases and data in patients with multiple lesions is lacking. We retrospectively analyzed clinical outcome including response rates, progression-free and overall survival in patients with at least 5 MBM who received ipi-nivo +/- radiotherapy (RT). Collection of data is ongoing; in an interim analysis 74 patients were included: Patients had a median age of 58 (range 26-83), 50 (68%) male, 56 (76%) patients with multiple (> 10) MBM at therapy start. 29 (39%) had symptomatic MBM controlled with a median of 12mg dexamethasone (range 4-24mg). At start of ipi-nivo 29 (39%) patients received WBRT and 17 (23%) SRS. In patients without RT 11/28 (39%) responded to ipi-nivo, 2 of them received 4 and 12mg dexamethasone. In patients with combined RT 4/17 (24%, SRS of up to 10 MBM) and 6/29 (21%, WBRT) responded. 6 or 12 weeks after the initiation of ipi-nivo another 4 patients received SRS and 8 patients WBRT as salvage RT. Overall survival did not significantly differ in patients with 5-9 or multiple MBM or dependent on the addition of RT, no matter if SRS or WBRT was applied.To conclude, ipi-nivo demonstrated efficacy independent from added RT in patients with multiple MBM.