PO-0746 The utility of functional magnetic resonance imaging in target delineation of high-grade gliomas
Year: 2019
Type: conference-abstract
Abstract: Purpose: to investigate efficacy and safety of concurrent stereotactic radiosurgery (SRS), either single-fraction SRS s-fSRS; 18-22 Gy) or fractionated (fSRS; 3x9 Gy) SRS and ipilimumab or nivolumab in patients with untreated melanoma brain metastases.Patients and Methods: Eighty consecutive patients with 326 melanoma BM, receiving SRS in combination with ipilimumab or nivolumab, were analyzed.Concurrent systemic treatment was generally started within 5 days before SRS and consisted of intravenous nivolumab or ipilimumab until disease progression or inacceptable toxicity.Primary endpoint of the study was intracranial progression-free survival (PFS).Secondary endpoints were extracranial PFS, overall survival (OS), and toxicity.Results: Eighty patients were analyzed.Forty-five patients received SRS and ipilimumab (SRS+ipilimumab), and 35 patients SRS and nivolumab (SRS+nivolumab).With a median follow-up of 15 months, the 6-month and 12month intracranial PFS rates were 69% (95%CI,54-87%) and 42% (95%CI,24-65%) in SRS+nivolumab group and 48% (95%CI,34-64%) and 17% (95%CI,5-31%) in SRS+ipilimumab group (p=0.02),respectively.Similarly, patients treated with SRS and nivolumab had better 6-month extracranial PFS and 12-month OS (SRS+nivolumab, 57% and 37%; SRS+ipilimumab, 42% and 17%).Stratification for type of SRS showed that combined CPIs and fSRS were associated with better intracranial PFS; 6-month and 12-month rates were 70% and 40%, respectively, for patients receiving fSRS and 46% and 10%, respectively, for those undergoing sf-SRS (p=0.01).As for intracranial PFS, fSRS resulted in better extracranial PFS.Grade 3 treatment-related adverse events occurred in 24% of patients receiving SRS and ipilimumab and 17% of patients receiving SRS and nivolumab.Conclusions: In conclusion, concurrent SRS and CPIs show meaningful intracranial activity and acceptable toxicity in patients with either asymptomatic and symptomatic melanoma BM, particularly when fSRS is combined with nivolumab.Further studies need to investigate the potential stronger synergistic effect of fractionated radiation schedules and CPIs.
Source: Radiotherapy and Oncology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,000
OpenAlex ID: W2946322114