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.
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.
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
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
All authors have declared no conflicts of interest.