Ipilimumab plus nivolumab in patients with symptomatic melanoma brain metastasis requiring corticosteroids.

To investigate the efficacy of PD-1-directed antibody-based therapy in patients with symptomatic melanoma brain metastases (MBM) and concurrent treatment with corticosteroids. This retrospective cohort study included patients with cutaneous melanoma with symptomatic MBM and concurrent treatment with corticosteroids who received PD-1-directed antibody-based treatment at the Royal Marsden Hospital London between 2016 and 2021. The primary outcome was overall survival (OS), secondary outcomes were intracranial response rate (ORR) and duration of response (DOR). We used the Kaplan-Meier method to describe survival. Between 2016 and 2021, 256 patients presented with metastatic melanoma, of whom 29 were eligible with symptomatic MBM requiring corticosteroids and receiving ipilimumab plus nivolumab. Median age was 54 (interquartile range 44, 66). Median OS was 5.45 months (95% confidence interval (CI) 2.89, 29.40), with 21% of patients (95% CI 9%, 47%) alive after 3 years. ORR was 28% (8/29) and DOR was 7.85 months (95% CI 7.85, not estimably [NE]). Responding patients had a median OS of 56.4 months (95% CI 46.03, NE). Elevated lactate dehydrogenase and Eastern Cooperative Oncology Group PS> 2 were associated with poorer outcomes (median OS 29.4 versus 3.12 months and 6.44 versus 5.13 months), no such association was observed for corticosteroid dose, number of lesions, or line of treatment. Patients with symptomatic MBM derive only modest benefit from combination immunotherapy treatment. Nevertheless, those with disease response have the potential to derive long-term benefit, justifying ipilimumab plus nivolumab in this group in the absence of other more effective treatment options. • Metastatic melanoma frequently presents with symptomatic brain metastasis. • Ipilimumab plus nivolumab has modest efficacy in those patients. • Responding patients to ipilimumab plus nivolumab may derive long-term benefit. • Even patients with high-dose corticosteroids may respond to ipilimumab & nivolumab. [ABSTRACT FROM AUTHOR]