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Hassel, Jessica C. ; Schank, Timo E. ; Smetak, Heiko ; Mühlbauer, Jasmin ; Salzmann, Martin ; Machiraju, Devayani ; Menzer, Christian ; Lang, Kristin ; König, Laila ; Haefner, Matthias F. ; Hülsmeyer, Ingrid ; Kohler, Christian ; Spang, Rainer ; Enk, Alexander ; Debus, Jürgen ; Beckhove, Philipp

Evaluation of radio-immunotherapy sequence on immunological responses and clinical outcomes in patients with melanoma brain metastases (ELEKTRA)

Hassel, Jessica C., Schank, Timo E., Smetak, Heiko, Mühlbauer, Jasmin, Salzmann, Martin, Machiraju, Devayani, Menzer, Christian, Lang, Kristin, König, Laila, Haefner, Matthias F., Hülsmeyer, Ingrid, Kohler, Christian , Spang, Rainer , Enk, Alexander, Debus, Jürgen and Beckhove, Philipp (2022) Evaluation of radio-immunotherapy sequence on immunological responses and clinical outcomes in patients with melanoma brain metastases (ELEKTRA). Oncoimmunology 11 (1), p. 2066609.

Date of publication of this fulltext: 16 May 2022 04:42
Article
DOI to cite this document: 10.5283/epub.52281


Abstract

In patients with melanoma brain metastases (MBM), a combination of radiotherapy (RT) with immune checkpoint inhibitors (ICI) is routinely used. However, the best sequence of radio-immunotherapy (RIT) remains unclear. In an exploratory phase 2 trial, MBM patients received RT (stereotactic or whole-brain radiotherapy depending on the number of MBM) combined with ipilimumab (ipi) +/- nivolumab ...

In patients with melanoma brain metastases (MBM), a combination of radiotherapy (RT) with immune checkpoint inhibitors (ICI) is routinely used. However, the best sequence of radio-immunotherapy (RIT) remains unclear. In an exploratory phase 2 trial, MBM patients received RT (stereotactic or whole-brain radiotherapy depending on the number of MBM) combined with ipilimumab (ipi) +/- nivolumab (nivo) in different sequencing (Rad-ICI or ICI-Rad). Comparators arms included patients treated with ipi-free systemic treatment or without RT (in MBM-free patients). The primary endpoints were radiological and immunological responses in the peripheral blood. Secondary endpoints were progression-free survival (PFS) and overall survival (OS). Of 106 screened, 92 patients were included in the study. Multivariate analysis revealed an advantage for patients starting with RT (Rad-ICI) for overall response rate (RR: p = .007; HR: 7.88 (95%CI: 1.76-35.27)) and disease control rate (DCR: p = .036; HR: 6.26 (95%CI: 1.13-34.71)) with a trend for a better PFS (p = .162; HR: 1.64 (95%CI: 0.8-3.3)). After RT plus two cycles of ipi-based ICI in both RIT sequences, increased frequencies of activated CD4, CD8 T cells and an increase in melanoma-specific T cell responses were observed in the peripheral blood. Lasso regression analysis revealed a significant clinical benefit for patients treated with Rad-ICI sequence and immunological features, including high frequencies of memory T cells and activated CD8 T cells in the blood. This study supports increasing evidence that sequencing RT followed by ICI treatment may have better effects on the immunological responses and clinical outcomes in MBM patients.



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Details

Item typeArticle
Journal or Publication TitleOncoimmunology
Publisher:TAYLOR & FRANCIS INC
Place of Publication:PHILADELPHIA
Volume:11
Number of Issue or Book Chapter:1
Page Range:p. 2066609
Date16 April 2022
InstitutionsLeibniz Institute for Immunotherapy (LIT)
Medicine > Institut für Funktionelle Genomik > Lehrstuhl für Statistische Bioinformatik (Prof. Spang)
Informatics and Data Science > Department Computational Life Science > Lehrstuhl für Statistische Bioinformatik (Prof. Spang)
Identification Number
ValueType
35481285PubMed ID
10.1080/2162402X.2022.2066609DOI
Classification
NotationType
Brain Neoplasms/radiotherapyMESH
HumansMESH
Ipilimumab/therapeutic useMESH
Melanoma/drug therapyMESH
Progression-Free SurvivalMESH
RadioimmunotherapyMESH
KeywordsREGULATORY T-CELLS; STEREOTACTIC RADIOSURGERY; COMBINED NIVOLUMAB; ACQUIRED-RESISTANCE; RADIOTHERAPY; IPILIMUMAB; CANCER; RADIATION; BLOCKADE; SURVIVAL; Melanoma; brain metastases; radiation; immune checkpoint inhibitors; treatment sequence; immune monitoring; biomarkers
Dewey Decimal Classification600 Technology > 610 Medical sciences Medicine
600 Technology > 610 Medical sciences Medicine
StatusPublished
RefereedYes, this version has been refereed
Created at the University of RegensburgPartially
URN of the UB Regensburgurn:nbn:de:bvb:355-epub-522813
Item ID52281

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