Selected studies assessing the efficacy and toxicity of SRS and immunotherapy for the treatment of melanoma brain metastases

AuthorsPatients (n)TreatmentMedian survival (months)Brain controlNeurotoxicityBrain necrosis (% of patients)
Knisely et al., 2012 [22]16Ipi after SRS21.3NRNRNR
11Ipi before SRS19.8NRNRNR
50SRS alone4.9NRNRNR
Kiess et al., 2015 [23]15Concurrent SRS and Ipi (within 1 month)1-year 65%1-year LC 100%Grade 2, 33% Grade 3, 26%Early and late RN 50% of patients treated during or before Ipi and 13% of patients treated after Ipi.
19Nonconcurrent, SRS before Ipi (median 3 months)1-year 56%1-year LC 87%Grade 2, 10% Grade 3, 6% Grade 4, 3%
12Nonconcurrent, SRS after Ipi (median 2 months)1-year 40%1-year LC 89%
Ahmed et al., 2016 [24]26SRS/SRT and Nivo78% (1-year 55%)6-month and 1-year DBC 61 and 38% 6-month and 1-year LC 89 and 82%Grade 2, 37%27%
Qian et al., 2016 [25]33SRS and concurrent IPI (1) or Pembro (14)19.1NRNRNR
42Nonconcurrent SRS and Ipi (35) or Pembro (7)9NRNRNR
Choong et al., 2017 [26]28Concurrent SRS and Ipi (within 6 weeks)7.5 (1-year 40%)7.5 monthsNR0%
11Concurrent SRS and Nivo (within 6 weeks)20.4 (1-year 78%)12.7 monthsNR18%
Cohen-Inbar et al., 2017 [27]32Ipi before or during SRS1-year 59.4%1-year LC and DBF 54.4 and 15.8%NR31%
14Ipi after SRS1-year 33%1-year LC and DBF 16.5 and 26.8%NR7%
Gaudi-Marqueste et al., 2017 [28]21SRS before Ipi (21), Nivo (17), both (6)Ipi, 8.6 (1-year 41.2%) Nivo,12 (1-year 63%)NRNRNR
Patel et al., 2017 [29]20Ipi plus SRS (whitin 4 months)8 (1-year 37.1%)1-year LC and DBF 71 and 12%NR18% at 1 year
Skrepnik et al., 2017 [30]25Ipi before or concurrent (within 1 month)35 (1-year and 2-year 83 and 64%)16.7 (1-year and 2-year 52 and 34.8%)NR20.7 5% symptomatic
Chen et al., 2018 [31]23 (28)°concurrent SRS-SRT and Ipi or Pembro24.7 (1-year 75%)1-year LC 88%Grade 2, 42% Grade 3, 0%27% of 22 metastases confirmed by histology
12 (51)°Nonconcurrent SRS-SRT and Ipi or Pembro14.5 (1-year 53%)1-year LC 79%Grade 2, 35% Grade 3, 33%
Nardin et al., 2018 [32]25SRS and Pembro15.38.4 (6-months LC 80%)NR6.8%
Current series45concurrent SRS-SRT and Nivo (within 1 week)22 (1-year 78%)1-year 42% 1-year LC and DBC 85 and 46%Grade 3, 11%25% at 1-year
35Concurrent SRS-SRT and Ipi (within 1 week)14.7 (1-year 68%)1-year 17% 1-year LC and DBC 70 and 20%Grade 3, 6%17% at 1 year

Ipi Ipilimumab, Nivo Nivolumab, Pembro Pembrolizumab, SRS Stereotactic radiosurgery, SRT Stereotactic radiotherapy, LC local control, DBC distant brain control, NR not reported; ° Study including patients with brain metastases from melanoma, non small-cell lung cancer, and renal cell carcinoma