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Poster display session

1248 - Melanoma Brain Metastases Patients Treated with Stereotactic Radiosurgery and Ipilimumab versus Stereotactic Radiosurgery Alone: A Systematic Review with Meta-Analysis

Date

10 Sep 2017

Session

Poster display session

Presenters

Steven Nguyen

Citation

Annals of Oncology (2017) 28 (suppl_5): v403-v427. 10.1093/annonc/mdx376

Authors

S.M. Nguyen1, A. Castrellon2, O. Vaidis3, A. Johnson4

Author affiliations

  • 1 College Of Medicine, University of Central Florida, 32832 - Orlando/US
  • 2 Breast Cancer Center, Memorial Cancer Institute, 33021 - Hollywood/US
  • 3 Department Of Mathematics & Statistics, University of South Florida, 33620 - Tampa/US
  • 4 Department Of Computer Science, University of Houston, 77204 - Houston/US
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Resources

Abstract 1248

Background

The synergistic effects of radiotherapy and novel immunotherapy agents have shown renewed interest in cancer management. We examined survival outcomes in melanoma brain metastases (MBM) patients treated with stereotactic radiosurgery (SRS) and ipilimumab immunotherapy. We compared these outcomes with those of MBM patients receiving SRS without added immunotherapy.

Methods

We conducted the first systematic review with meta-analysis of studies comparing combined SRS and ipilimumab with SRS only in MBM. The protocol was published in the PROSPERO register for systematic reviews. MEDLINE and CENTRAL databases were searched using PRISMA method by three separate reviewers. Studies that examined SRS and ipilimumab compared to SRS without ipilimumab in MBM were included. Newcastle-Ottawa Scale Risk of Bias Assessment and the GRADE evidence quality rating method were used for qualitative appraisal. Statistical analysis was performed using Review Manager.

Results

We found 37 publications in our search and identified 4 retrospective studies to further assess; 3 studies were chosen for pooled-analysis. Evidence for survival benefits with combined treatment was rated “low”, per GRADE method. Meta-analysis of 222 patients confirmed significant survival advantage for SRS and ipilimumab (pooled median survival: 16.8 vs. 6.2 months; HR 0.38, 95% CI: [0.28 – 0.52]; p 

Conclusions

Combining stereotactic radiosurgery and ipilimumab in melanoma brain metastases can dramatically improve survival rate compared to stereotactic radiosurgery without immunotherapy. There is no increased risk of radiation necrosis and/or intracranial bleeding with combining radiation and immunotherapy in this setting.

Clinical trial identification

Legal entity responsible for the study

University of Central Florida College of Medicine

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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