Combination of radiation and immunotherapy in melanoma with brain metastases

The authors evaluated the effect of combination treatment of nivolumab (Opdivo) and a type of radiation therapy for the treatment of melanoma spread to the brain. The authors found out that this radiation therapy was well tolerated and produced better survival in melanoma patients who also received nivolumab.

In advanced melanoma, the cancer often spreads to the brain (brain metastasis). This affects quality of life and also shortens the life span of patients. Immunotherapy is a promising treatment option for this disease. It uses the body’s own immune system to fight cancer. Nivolumab is an example of immunotherapy that works by inhibiting PD-1, an important protein in the immune system. This inhibition triggers the immune system to attack tumor cells and kill them.

Stereotactic radiosurgery (SRS), a nonsurgical radiation therapy, is a common treatment in melanoma brain metastases (BMs). It specifically targets the tumors in the brain and protects the healthy cells.

However, little is known about the combination treatment of nivolumab and SRS for melanoma spread to brain.

The authors aimed to assess outcomes in patients receiving nivolumab and SRS for the treatment of BMs in melanoma.

In this study, 26 patients with 73 BMs were included. All patients were treated with SRS within 6 months of receiving nivolumab.  For 45% of tumors, radiation was administered before nivolumab treatment. For 7% of tumors, radiation was administered during nivolumab treatment. For 48% of tumors, radiation was administered after nivolumab treatment. The follow-up interval was every 2-3 months.

The treatment was generally well tolerated. One patient had moderate headache following SRS. 11% of BMs had an increase in tumor volume following SRS. 91% of BMs were controlled at the end of 6 months following SRS. 85% were controlled at the end of 12 months following SRS. The average overall survival (time from treatment until death from any cause) from the time of receiving SRS was 11.8 months. It was 12 months from the start of nivolumab treatment.

The authors concluded that SRS was well tolerated in patients receiving nivolumab. They further indicated that overall survival and control of brain metastases were better with radiation therapy and nivolumab. 

A larger patient population is needed for the results of this study to be widely applied. 

Please talk to your doctor about stereotactic radiaosurgery if the brain metastases cannnot be operated.