Can an Immunotherapy Combination Improve Outcomes in Patients With Melanoma Metastatic to the Brain?
Approximately 75% of patients with melanoma develop brain metastases before death, which has an extremely poor progonosis (median overall survival, 4-5 mo). The phase 2 CheckMate 204 trial recently published data that showed combining the CTLA4 inhibitor ipilimumab (Yervoy) with the PD-1 inhibitor nivolumab (Opdivo) can arrest or shrink brain tumors in many patients. Findings were reported for 94 patients with stage 4 melanoma who were followed for a median of 14 months. The intracranial benefit rate was 57%, calculated by combining rates of intracranial complete response (26%), partial response (30%), and stable disease (2%). At 9 months follow-up, 60% of patients had experienced no brain tumor progression, and 83% of patients were still alive.
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Tawbi HA, Forsyth PA, Algazi A, et al. Combined nivolumab and ipilimumab in melanoma metastatic to the brain. N Engl J Med. 2018;379(8):722-730. doi: 10.1056/NEJMoa1805453.