Introduction: Ipilimumab, an immunotherapy known to improve survival in patients with advanced systemic melanoma, has also demonstrated activity in patients with brain metastases, particularly when tumors are small, asymptomatic, and patients are not using corticosteroids. Through a case series review, we aimed to assess the value of surgical resection in the context of systemic therapy with ipilimumab, looking at changes in performance status, corticosteroid dose, and survival.
Methods: All patients with melanoma and brain metastases who received ipilimumab and underwent craniotomy for tumor resection between 2008 and 2012 at the Massachusetts General Hospital were identified through retrospective chart review. We restricted our final analysis to patients who underwent craniotomy within 3 months prior to initiation of therapy or up to 6 months after cessation of ipilimumab administration.
Results: 19 patients received ipilimumab and also underwent craniotomy for tumor. Of this group, 11 patients fit the inclusion criteria based on timing of therapy (median age 56, range 39 to 72). Median number of metastases at time of craniotomy was 2 (range 1 to >20). Median number of ipilimumab doses was 4 (range 2 to 4). All courses of ipilimumab were stopped for disease progression. 8 of 11 patients had improvement in their performance status following craniotomy. Of the 4 patients on corticosteroids prior to craniotomy, only 1 patient tolerated corticosteroid dose reduction after surgery. 10 of 11 patients had died by time of data collection, with the 1 living person lost to follow-up. Median survival after start of ipilimumab treatment was 7 months.
Conclusions: This series documents the characteristics of patients who underwent craniotomy for resection of brain metastases in close time proximity to receiving ipilimumab. While surgery improved performance status in the majority of cases, most patients on corticosteroids continued to require them post-operatively, and there was no impact on overall survival.
Patient Care: This case series highlights outcomes for patients with intracranial metastatic melanoma.
Learning Objectives: By the conclusion of this session, participants should be able to better understand the impact of ipilumumab and craniotomy for tumor resection in advanced melanoma.