Abstract
PURPOSE: Patients with melanoma brain metastases (MBM) have a poor prognosis despite improvements in treatments. The combination of ipilimumab and nivolumab remains the standard of care for this patient population and there is limited data on the combination of nivolumab and relatlimab (nivo-rela) in MBM. PATIENTS AND METHODS: We performed a retrospective cohort study of patients with MBM treated with nivo-rela from May 2022 to December 2023 at two academic institutions in Boston, MA. Information pertaining to patient demographics, survival, timing of therapy (radiation, nivo-rela), response rates and adverse events were collected. Progression-free survival and overall survival were calculated. RESULTS: A total of 39 patients were identified with a median follow-up of 26 months. Most patients were male (25 of 39 [64.1%]), with a median age of 69 years (range 31-87 years). Estimated survival rates were 79% (95% CI: 63% to 89%) at one year and 69% (95% CI: 50% to 82%) at two years following MBM diagnosis. We saw intracranial clinical benefit (response or stable disease) in 19 of 39 (48.7%) patients. Extracranial response was largely concordant with intracranial benefit with durable clinical benefit, defined as CR, PR or SD for 6 months, in 14 of 39 (35.9%) patients. A total of 30 patients (77%) received radiation therapy (SRT or both WBRT and SRT). Among them, 46.7% (14 of 30) showed either a decrease or stable intracranial disease after starting nivo-rela, compared to 55.6% (5 of 9) in the non-radiation therapy group. CONCLUSION: The combination of nivo-rela showed intracranial activity in patients with MBM, particularly in the front-line setting. Prospective trials are needed to validate these findings and provide data on the optimal use of systemic and local therapies in this challenging patient population.