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Long-Term Outcomes With Nivolumab Plus Ipilimumab for Melanoma Brain Metastases

By: Joseph Fanelli
Posted: Monday, November 4, 2019

According to the findings from the phase II ABC trial, presented at the European Society for Medical Oncology (ESMO) Congress 2019 in Barcelona (Abstract 1311O) and published in the Annals of Oncology, using nivolumab plus ipilimumab before surgery or radiation therapy may result in more “durable” intracranial responses for patients with melanoma brain metastases. The upfront treatment demonstrated positive responses in the majority of patients enrolled, with no new adverse events, concluded Georgina V. Long, PhD, of the Melanoma Institute Australia and the Royal North Shore Hospital at the University of Sydney, and colleagues.

In this collaboration study, the investigators divided 76 patients into three cohorts. Patients with asymptomatic brain metastases and no prior local brain therapy were placed in cohorts A and B; they received either nivolumab plus ipilimumab or nivolumab alone, respectively. All patients who previously failed to respond to local therapy, exhibited neurologic symptoms, and had leptomeningeal disease were placed in cohort C; they were treated with nivolumab.

In cohorts A, B, and C, the patients exhibited intracranial response rates of 51%, 20%, and 6%, respectively, and extracranial response rates of 57%, 29%, and 25%, respectively. Complete intracranial response was observed in cohorts A (26%) and B (16%). In cohort A—those patients treated with nivolumab plus ipilimumab—the intracranial progressive-free survival rates were 49% at both 12 months and 24 months, and the investigators reported a 63% overall survival rate at both 12 and 24 months. Cohorts B and C both reported lower intracranial progressive-free and overall survival rates at 12 and 24 months. Additionally, for the 27 drug-treatment–naive patients in cohort A, a 59% intracranial rate and a 56% 24-month intracranial progression-free survival rate were reported.

No treatment-related deaths were observed in any of the cohorts. Treatment-related adverse events of grade 3 or 4 were reported in 54% of cohort A, 20% of cohort B, and 13% of cohort C.

Disclosure: For full disclosures of the study authors, visit academic.oup.com.



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