Ipilimumab in patients with melanoma and brain metastases: an open-label, phase 2 trial
Abstract
Background Brain metastases commonly develop in patients with melanoma and are a frequent cause of death of patients with this disease. Ipilimumab improves survival in patients with advanced melanoma. We aimed to investigate the safety and activity of this drug specifically in patients with brain metastases.Methods Between July 31, 2008, and June 3, 2009, we enrolled patients with melanoma and brain metastases from ten US centres who were older than 16 years into two parallel cohorts. Patients in cohort A were neurologically asymptomatic and were not receiving corticosteroid treatment at study entry; those in cohort B were symptomatic and on a stable dose of corticosteroids. Patients were to receive four doses of 10 mg/kg intravenous ipilimumab, one every 3 weeks. Individuals who were clinically stable at week 24 were eligible to receive 10 mg/kg intravenous ipilimumab every 12 weeks. The primary endpoint was the proportion of patients with disease control, defined as complete response, partial response, or stable disease after 12 weeks, assessed with modified WHO criteria. Analyses of safety and efficacy included all treated patients. This trial is registered with ClinicalTrials.gov, number NCT00623766.Findings We enrolled 72 patients: 51 into cohort A and 21 into cohort B. After 12 weeks, nine patients in cohort A exhibited disease control (18%, 95% CI 8-31), as did one patient in cohort B (5%, 0·1-24). When the brain alone was assessed, 12 patients in cohort A (24%, 13-38) and two in cohort B (10%, 1-30) achieved disease control. We noted disease control outside of the brain in 14 patients (27%, 16-42) in cohort A and in one individual (5%, 0·1-24) in cohort B. The most common grade 3 adverse events in cohort A were diarrhoea (six patients [12%]) and fatigue (six [12%]); in cohort B, they were dehydration (two individuals [10%]), hyperglycaemia (two [10%]), and increased concentrations of serum aspartate aminotransferase (two [10%]). One patient in each cohort had grade 4 confusion. The most common grade 3 immune-related adverse events were diarrhoea (six patients [12%]) and rash (one [2%]) in cohort A, and rash (one individual [5%]) and increased concentrations of serum aspartate aminotransferase (two [10%]) in cohort B. One patient in cohort A died of drug-related complications of immune-related colitis.Interpretation Ipilimumab has activity in some patients with advanced melanoma and brain metastases, particularly when metastases are small and asymptomatic. The drug has no unexpected toxic effects in this population.Funding Bristol-Myers Squibb.
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A study in a cohort of patients with melanoma and brain metastasis suggested a negative effect of steroid use on ipilimumab activity.
“A study in a cohort of patients with melanoma and brain metastasis suggested a negative effect of steroid use on ipilimumab activity.42”
From Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: Review of the literature and personalized risk-based prevention strategy (2020) · cites this paper as [42]
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- Authors
- Margolin, K., Ernstoff, M. S., Hamid, O., Lawrence, D., McDermott, D., Puzanov, I., Wolchok, J. D., Clark, J. I., Sznol, M., Logan, T. F., Richards, J., Michener, T., Balogh, A., Heller, K. N., & Hodi, F. S.
- Affiliations
- University of Washington (US)
- Dartmouth–Hitchcock Medical Center (US)
- Angeles Clinic and Research Institute (US)
- Massachusetts General Hospital (US)
- Beth Israel Deaconess Medical Center (US)
- Vanderbilt University Medical Center (US)
- Memorial Sloan Kettering Cancer Center (US)
- Loyola University Chicago (US)
- Yale Cancer Center (US)
- Indiana University Health (US)
- Oncology Specialists (US)
- Bristol-Myers Squibb (United States) (US)
- Dana-Farber Cancer Institute (US)
- Corresponding author
- Margolin, Kim
- ORCID
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2012-05
- Volume
- 13
- Issue
- 5
- Pages
- 459-465
- ISSN
- 1470-2045 (ISSN-L)
- OpenAlex
- W2103220202
- Cited by
- 1,091
- References
- 36
- Citations by year
- 2026: 10 · 2025: 23 · 2024: 42 · 2023: 56 · 2022: 71 · 2021: 89 · 2020: 117 · 2019: 82 · 2018: 109 · 2017: 109 · 2016: 100 · 2015: 99 · 2014: 61 · 2013: 81 · 2012: 39
- FWCI
- 72.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Brain Metastases and Treatment
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Keywords
- ipilimumab, melanoma, brain metastases, immune checkpoint inhibitors, disease control, corticosteroid use, adverse events, immune-related adverse events, neurotoxicity, treatment safety, anticancer activity, fatigue, confusion, hyperglycemia, aspartate aminotransferase elevation, dehydration
- MeSH terms
- Ipilimumab, Adult, Aged, Antibodies, Monoclonal, Antineoplastic Agents, Brain Neoplasms, Female, Humans, Male, Melanoma, Middle Aged, Prospective Studies, Skin Neoplasms, Treatment Outcome
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