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• W1995670127 abstract "Ipilimumab (ipi) is a monoclonal antibody that blocks cytotoxic T lymphocyte-associated antigen 4 and improves overall survival (OS) in patients with metastatic melanoma (MM). Since many patients with MM require extra-cranial radiation therapy (RT), we assessed the tolerability and efficacy non-brain RT during ipi for MM. After IRB approval, medical records of patients treated with ipi for MM were reviewed. RT details were recorded. CTCAE 4.0 grade ≥3 radiation-related (rr) and immune-related (ir) adverse events (AE) were recorded. Locoregional control and symptom relief after postoperative and palliative RT were recorded, respectively. Investigator judged systemic response to ipi 12 weeks after initiating immunotherapy and OS were assessed. Between 2005 and 2011, 335 patients were treated with ipi for MM at our institution. Of these patients, 19 (6%) received 20 courses of extra-cranial RT (1 postoperative, targeting the axilla; 19 palliative, targeting 8 bone metastases, 7 lymph node and/or cutaneous metastases, 4 recurrent unresectable tumors, 1 leptomeningeal metastasis) between the first and fourth dose of ipi. Doses of 20-62.5 Gy in 1-25 fractions (median 30 Gy in 5 fractions) were used. Most patients (n=13, 68%) received ipi at 3 mg/kg. Grade ≥3 rrAEs and irAEs were observed in 2 (11%) and 6 (32%) patients, respectively. Locoregional recurrence did not occur in the patient undergoing postoperative RT. Eleven of 13 (85%) receiving palliative RT reported decrease in symptom severity: pain (5), diplopia (1), hemorrhage (3), mass effect (2); palliation was not assessable in 3 patients. Three patients were treated for asymptomatic metastases that stabilized radiographically and never became symptomatic. Systemic partial and mixed responses were seen in 1 and 3 patients, with stable disease in 2, for a systemic disease control rate of 32%. Median OS after initiating ipi was 6 months (range 1.5 months - 3.5 years); 1 and 3 year OS rates were 26% and 12%. This is the first report detailing the tolerance and efficacy of RT during ipi for MM. Rates of rrAEs and irAEs do not suggest increased toxicity with this therapeutic combination. Ipi did not appear to compromise the efficacy of postoperative or palliative RT. Low response and OS rates likely reflect the selection of patients with symptomatic, progressive MM for RT. Further study of this therapeutic combination is warranted.Poster Viewing Abstract 3158; TableGrade 3+ Adverse Events Among Patients Receiving Extra-Cranial Radiation therapy During IpilimumabAdverse Event (AE)Ipi dose (mg/kg)RT dose (Gy)# of fractionsRT siteTime from Ipi start to AE (days)Time from RT start to AE (days)AE attribution# of patients experiencingGrade 3 cytokine release syndrome10241T7 and T1272ir and/or rr1Grade 4 uveitis10205Orbit and skull base*second course of RT to this site11861126ir and/or rr1Grade 3 diarrhea32510Skull base3632ir1Grade 3 AST/ALT abnormality103010Right humerus104100ir1Grade 3 AST/ALT abnormality10303Suboccipital lymph node35(prior to RT)ir1Grade 3 maculo-papular rash33010Leptomeningeal melanomatosis**rash occurred outside RT field, after vemurafenib9864ir1Grade 3 AST/ALT abnormality1062.525Axillary lymph node6394ir1* second course of RT to this site** rash occurred outside RT field, after vemurafenib Open table in a new tab" @default.
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• W1995670127 date "2012-11-01" @default.
• W1995670127 modified "2023-10-05" @default.
• W1995670127 title "Tolerance and Efficacy of Extracranial Radiation Therapy During Ipilimumab Immunotherapy for Metastatic Melanoma" @default.
• W1995670127 doi "https://doi.org/10.1016/j.ijrobp.2012.07.1745" @default.
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