TY - JOUR T1 - Combined immune checkpoint blockade for metastatic uveal melanoma: a retrospective, multi-center study JF - Journal for ImmunoTherapy of Cancer JO - J Immunother Cancer DO - 10.1186/s40425-019-0800-0 VL - 7 IS - 1 SP - 299 AU - Markus V. Heppt AU - Teresa Amaral AU - Katharina C. Kähler AU - Lucie Heinzerling AU - Jessica C. Hassel AU - Markus Meissner AU - Nicole Kreuzberg AU - Carmen Loquai AU - Lydia Reinhardt AU - Jochen Utikal AU - Evelyn Dabrowski AU - Anja Gesierich AU - Claudia Pföhler AU - Patrick Terheyden AU - Kai-Martin Thoms AU - Lisa Zimmer AU - Thomas K. Eigentler AU - Michael C. Kirchberger AU - Henner M. Stege AU - Friedegund Meier AU - Max Schlaak AU - Carola Berking Y1 - 2019/12/01 UR - http://jitc.bmj.com/content/7/1/299.abstract N2 - Background Uveal melanoma (UM) is highly refractory to treatment with dismal prognosis in advanced stages. The value of the combined checkpoint blockade with CTLA-4 and PD-1 inhibition in metastatic UM is currently unclear.Methods Patients with metastatic or unresectable UM treated with ipilimumab in combination with a PD-1 inhibitor were collected from 16 German skin cancer centers. Patient records of 64 cases were analyzed for response, progression-free survival (PFS), overall survival (OS), and safety. Clinical parameters and serum biomarkers associated with OS and treatment response were determined with Cox regression modelling and logistic regression.Results The best overall response rate to combined checkpoint blockade was 15.6% with 3.1 and 12.5% complete and partial response, respectively. The median duration of response was 25.5 months (range 9.0–65.0). Stable disease was achieved in 21.9%, resulting in a disease control rate of 37.5% with a median duration of the clinical benefit of 28.0 months (range 7.0–65.0). The median PFS was 3.0 months (95% CI 2.4–3.6). The median OS was estimated to 16.1 months (95% CI 12.9–19.3). Regarding safety, 39.1% of treated patients experienced a severe, treatment-related adverse event according to the CTCAE criteria (grade 3: 37.5%; grade 4: 1.6%). The most common toxicities were colitis (20.3%), hepatitis (20.3%), thyreoiditis (15.6%), and hypophysitis (7.8%). A poor ECOG performance status was an independent risk factor for decreased OS (p = 0.007).Conclusions The tolerability of the combined checkpoint blockade in UM may possibly be better than in trials on cutaneous melanoma. This study implies that combined checkpoint blockade represents the hitherto most effective treatment option available for metastatic UM available outside of clinical trials.Abbreviations:AEAdverse eventCIConfidence intervalCRPC-reactive proteinCTCAECommon Terminology Criteria for Adverse EventsDCRDisease control rateECOGEastern Cooperative Oncology GroupHRHazard ratioLDHLactate dehydrogenaseORROverall response rateOSOverall survivalPFSProgression-free survivalQ2WEvery two weeksQ3WEvery three weeksRECRelative eosinophil countRLCRelative lymphocyte countRNCRelative neutrophil countUMUveal melanoma ER -