Thursday, December 31, 2015

Brain mets treated with SRS and Nivo (Opdivo)....anti-PD1 works in the brain! Redux!

Clinical outcomes of melanoma brain metastases treated with stereotactic radiation and anti-PD-1 therapy.  Ahmed, Stallworth, Kim, Weber et al.  Ann Oncol. 27 Dec 2015.

"Data were analyzed retrospectively from two prospective nivolumab protocols enrolling 160 patients with advanced resected and unresectable melanoma at a single institution. Patients were included if BMs were diagnosed and treated with stereotactic radiation within 6 months of receiving nivolumab. The primary endpoint of this study was neurotoxicity; secondary endpoints included BM control and survival.

Twenty-six patients with a total of 73 BMs treated over 30 sessions were identified. Radiation was administered prior to, during and after nivolumab in 33 lesions (45%), 5 lesions (7%), and 35 lesions (48%), respectively. All BMs were treated with stereotactic radiosurgery (SRS) in a single session except 12 BMs treated with fractionated stereotactic radiation therapy, nine of which were in the post-operative setting. One patient experienced grade 2 headaches following SRS with symptomatic relief with steroid treatment. No other treatment-related neurologic toxicities or scalp reactions were reported. Eight (11%) local BM failures with a ≥ 20% increase in volume were noted. Of these lesions, hemorrhage was noted in 4, and edema was noted in 7. Kaplan-Meier estimates for local BM control following radiation at 6 and 12 months was 91% and 85%, respectively. Median overall survival (OS) from date of stereotactic radiation and nivolumab initiation was 11.8 and 12.0 months, respectively, in patients receiving nivolumab for unresected disease (median OS was not reached in patients treated in the resected setting).

In our series, stereotactic radiation to melanoma BMs is well tolerated in patients who received nivolumab. BM control and OS appear prolonged compared to standard current treatment."

Kind-of a cheater's report by the researchers as this just compiles figures gleaned from ratties already in other studies with proof that Nivo and SRS to brain mets are safe when given together and provide positive benefits, but does not include that much info about results.  In fact, I am sure that some of my fellow ratties are included within these numbers.  I may be as well, though the time between my SRS to the brain (April 27, 2010) and first dose of Nivo (December 29, 2010) is greater than 6 months noted in the abstract. 

Great thanks to Eric and B who keep me apprised of all things melanoma in the best possible way.  I get tickled when they send me notifications of the same data within moments of one another!!  Love my boys! Enjoy your last moments of 2015!!! - c

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