OBJECT In patients with large or symptomatic brain lesions from metastatic
melanoma, the value of resection of
metastases to facilitate administration of systemic
ipilimumab therapy has not yet been described. The authors undertook this study to investigate whether
craniotomy creates the opportunity for patients to receive and benefit from
ipilimumab who would otherwise succumb to brain
metastasis prior to the onset of regression. METHODS All patients with metastatic
melanoma who received
ipilimumab and underwent
craniotomy for
metastasis resection between 2008 and 2014 at the Massachusetts General Hospital were identified through retrospective chart review. The final analysis included cases involving patients who underwent
craniotomy within 3 months prior to initiation of
therapy or up to 6 months after cessation of
ipilimumab administration. RESULTS Twelve patients met the inclusion criteria based on timing of
therapy (median age 59.2). The median number of
metastases at the time of
craniotomy was 2. The median number of
ipilimumab doses received was 4. Eleven of 12 courses of
ipilimumab were stopped for
disease progression, and 1 was stopped for treatment-induced
colitis. Eight of 12 patients had improvement in their performance status following
craniotomy. Of the 6 patients requiring
corticosteroids prior to
craniotomy, 3 tolerated
corticosteroid dose reduction after surgery. Ten of 12 patients had died by the time of data collection, with 1 patient lost to follow-up. The median survival after the start of
ipilimumab treatment was 7 months. CONCLUSIONS In this series, patients who underwent resection of
brain metastases in temporal proximity to receiving
ipilimumab had qualitatively improved performance status following surgery in most cases. Surgery facilitated
corticosteroid reduction in select patients. Larger analyses are required to better understand possible synergies between
craniotomy for
melanoma metastases and
ipilimumab treatment.