The anti-
cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4)
monoclonal antibody ipilimumab has been shown to improve survival in patients with metastatic non-CNS
melanoma. The purpose of this study was to investigate the efficacy of
CTLA-4 inhibitors in the treatment of metastatic
melanoma with limited
brain metastases treated with stereotactic radiosurgery (SRS). Between January 2008 and June 2011, 58 patients with limited
brain metastases from
melanoma were treated with SRS with a median dose of 20 Gy delivered to the 50% isodose line (range, 15-20 Gy). In 25 patients,
ipilimumab was administered intravenously at a dose of 3 mg/kg over 90 min every 3 weeks for a median of four doses (range, 1-8). Local control (LC), freedom from new
brain metastases, and overall survival (OS) were assessed from the date of the SRS procedure. The median LC, freedom from new
brain metastases, and OS for the entire group were 8.7, 4.3, and 5.9 months, respectively. The cause of death was CNS progression in all but eight patients. Six-month LC, freedom from new
brain metastases, and OS were 65, 35, and 56%, respectively, for those who received
ipilimumab and 63, 47, and 46% for those who did not (P=NS).
Intracranial hemorrhage was noted in seven patients who received
ipilimumab compared with 10 patients who received SRS alone (P=NS). In this retrospective study, administration of
ipilimumab neither increased toxicity nor improved intracerebral disease control in patients with limited
brain metastases who received SRS.