1152 - Ipilimuamb treatment after electrochemotherapy could be an effective sequential combination approach

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Cytotoxic agents
Skin cancers
Therapy
Biological therapy
Presenter ester Simeone
Authors E. Simeone1, L. Benedetto2, G. Gentilcore1, C. Caracò1, G. Di Monta2, U. Marone1, A.M. Grimaldi1, S. Mori1, N. Mozzillo2, P.A. Ascierto1
  • 1Oncology, national cancer institute, 80131 - naples/IT
  • 2Surgical Oncology, national cancer institute, 80131 - naples/IT

Abstract

Backgroud

Electrochemotherapy (ECT) has shown to be effective as local treatment of disseminated superficial melanoma, but there is a lack of evidence of its potential systemic effect. Potential immunologic changes due to ECT could have an impact on metastatic lesions but this hasn't been demonstrated yet. Combining ECT with new drugs, like ipilimumab (ipi), could be a new therapeutic strategy. T-regulatory cells (T-Reg) are immunosuppressive lymphocytes whose role during ipi therapy has still to be clarified. Our previous experience showed a reduction of T-reg cells in patients responder to ipi.

Patients and methods

20 patients with advanced melanoma (8 at stage IIIc and 12 IV M1c) underwent ECT with bleomycine. 5 patients were treated with ECT and no further therapies, while 15 pts were treated with ECT first and then, after progression, with ipi at 3 mg/kg for 4 cycles. We collected PBMC of these patients. Blood draw was performed at ECT day 0-1-15-30 and during follow-up, while during ipi therapy, at each cycle (week 4-7-10) and at every tumor evaluation (every 12 weeks).

Results

5/20 (25%) patients, all at stage IIIc, had performed only ECT and showed a good local response (2 CR and 3 PR). No variation of T-Reg was detected after ECT treatment with median value of 0.40 % (range 0.40-2.6 %). 15/20 (75%) patients had a low local response and developed visceral progression after ECT without significant reduction of T-Reg levels. The median T-reg value was of 0.7 (range 0.50-2.6%) During ipi treatment, we found a decrease of T-Reg of 0.10% per cycle. This result was consistent with our previous evidence in patients treated with ipi in Italian EAP. Moreover, 3/15 patients (20%) showed local CR and 2 of them also systemic PR lasting at 12.1 months of follow- up, with a median T-Reg value of 0.10%. 8/15 (53%) had both local and systemic SD with a median TTP of 7.9 months and a median T-Reg of 0.30%. 4/15 (27%) developed a local and distant progression and we found a small decrease with median T-Reg of 1.8%.

Conclusion

ECT followed by ipi in patients with metastatic melanoma, may be more effective than ECT and ipi alone. This combination may represent a new option. Anyway, further studies are necessary to verify these data.

Disclosure

All authors have declared no conflicts of interest.