2617 - Real-World Use of Nivolumab plus Relatlimab in the Multi-Modal Management of Melanoma Brain Metastases
Presenter(s)
V. M. Khatri1, M. T. Aboujaoude2, J. M. Bryant3, J. Y. Nakashima3, D. Zhao3, L. Karapetyan4, T. Ahmad5, A. S. Brohl5, Z. Eroglu5, J. Markowitz5, N. I. Khushalani6, K. Rayn5, E. J. Wuthrick1, H. H. M. Yu1, D. E. Oliver1, and K. A. Ahmed1; 1H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, 2University of South Florida Morsani College of Medicine, Tampa, FL, United States, 3Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 4Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 5H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 6H. Lee Moffitt Cancer Center and Research Institute, Department of Cutaneous Oncology, Tampa, FL
Purpose/Objective(s): Fixed-dose combination nivolumab plus relatlimab (NIVO-RELA) improves progression-free survival (PFS) compared to nivolumab alone in untreated metastatic or unresectable melanoma. There is limited data using NIVO-RELA for treatment of melanoma brain metastases (MBM). We report our real-world multimodal experience in MBM using NIVO-RELA.
Materials/Methods: We retrospectively identified patients (pts) who received NIVO-RELA with MBM from 5/2022-2/2024. Pts had new, progressive, or untreated MBM up to 3 months prior to starting NIVO-RELA. Leptomeningeal disease (LMD) was excluded. Details of local therapy, including surgical resection, stereotactic radiosurgery (SRS), and whole brain radiation therapy (WBRT) were recorded. RT was considered concurrent if given during NIVO-RELA initiation or up to 108 days (4 half-lives) after last infusion. The primary endpoint (EP) was overall survival (OS), measured from NIVO-RELA initiation. Secondary EPs were intracranial PFS (IC-PFS), extracranial (EC-PFS), and overall PFS, from NIVO-RELA initiation, and local control (LC), distant control (DC), and symptomatic radiation necrosis (RN), from SRS.
Results: We identified 23 pts with MBM who received NIVO-RELA. Median age was 72 years (31-84), 18 (72%) patients were male, and 7 (30%) had neurologic symptoms at NIVO-RELA start. Median follow-up was 15.4 months (0.9-31.0). The median number of prior systemic therapies for metastatic melanoma was 2 (0-4). Median OS was not reached (NR) (95% CI, 8.5 months-NR), with a 12-month OS of 67%. Median IC-PFS was 8.5 months (95% CI 2.4-NR), with a 12-month IC-PFS of 50%. Median EC-PFS was 16.9 months (95% CI 2.5-NR), with a 12-month EC-PFS of 54%. Twenty-one (91%) pts received local therapy to 77 MBM, of which 4 (19%) had surgery, 21 (100%) SRS, and 4 (19%) WBRT. Three (4%) MBM received surgery alone, and 74 (96%) SRS over 26 courses. The median number of MBM treated per patient was 1.5 (range 1-19), and 2 per course (range 1-13). Five (6%) of the 74 SRS treated MBM received FSRT. SRS was concurrent with NIVO-RELA to 47 (64%) MBM. Four (5%) were treated post-operatively. Median dose for single fraction was 24 Gy (18-24). Median dose for FSRT was 30 Gy (25-36) in 5 fractions (3-5). Median gross tumor volume was 0.07 cc (0.01-35.64) and median planning tumor volume was 0.19 cc (0.06-53.76). Twelve-month LC was 94% and 12-month DC was 60% for SRS treated MBM. One (1%) lesion developed RN 26 months after SRS. No pt developed LMD. The 2 pts with NIVO-RELA alone had no intracranial or systemic progression, and remain alive at 12.7 and 15.4 months, without neurologic symptoms or steroid use.
Conclusion: Fixed-dose NIVO-RELA can be safely used in the multi-modal management of MBM with encouraging IC disease control. Prospective trials to define its role in this setting are needed.