Volume 2 Supplement 3

Abstracts of the 29th Annual Scientific Meeting of the Society for Immunotherapy of Cancer (SITC)

Open Access

Patterns of long-term survival following Ipilimumab (Ipi): the Memorial Sloan Kettering Cancer Center 10-year metastatic melanoma (MM) experience

  • David B Page1,
  • Jarushka Naidoo1,
  • Parisa Momtaz1,
  • Kita Bogatch1,
  • Deborah Kuk1,
  • Katherine Panageas1,
  • Jianda Yuan2,
  • Jedd D Wolchok1 and
  • Michael Postow1
Journal for ImmunoTherapy of Cancer20142(Suppl 3):P117

DOI: 10.1186/2051-1426-2-S3-P117

Published: 6 November 2014

Background

In two Phase III randomized trials in MM, Ipi improved median overall survival (OS) [1, 2]. Here, we evaluate OS and characterize post-Ipi treatment patterns among long-term survivors from a single-institution cohort of patients (pts) treated with Ipi.

Methods

Through a search of institutional databases, we identified 766 pts with MM treated with Ipi between 1/1/2003 and 12/31/2013. As of 4/1/2014, 96 pts have survived ≥2 yrs, measured from first dose of Ipi. OS was calculated utilizing the Kaplan-Meier method. Disease control was defined as the duration from initiation of Tx until initiation of subsequent systemic Tx or death.

Results

With a median follow-up of 17mo (range 0-9yr), the median OS for the entire cohort of 766 pts was 15mo, with a 2-yr OS of 41%. Of the 80 pts with OS ≥2 yrs post-Ipi for whom data are available, 75% (n = 60/80) remain alive and 30% (n = 24/80) remain progression-free following Ipi, with median Ipi disease control of 15mo (range: 3 to 107+mo). Among pts with progression (n = 56), 57% exhibited disseminated progression, 29% oligometastatic progression, and 15% CNS-only progression. The most frequent Tx at first progression was locoregional (n = 29), employed at a median of 11mo post-Ipi (range: 3 to 55mo) and associated with median 15+mos disease control (range 1 to 73+mo) (table 1). In pts requiring post-Ipi systemic Tx, long-term disease control was observed across multiple systemic Tx's (table 2).
Table 1

Pts receiving locoregional Tx at first progression.

Locoregional Tx

# pts

# pts achieving ≥1yr

disease control

CNS, surgery and/or RT

9/80 (11%)

5/9 (56%)

Non-CNS, surgery

11/80 (14%)

8/11 (73%)

Non-CNS, RT

6/80 (8%)

3/6 (50%)

Ablation

2/80 (3%)

1/2 (50%)

Table 2

Post-Ipi Systemic Txs.

Post-Ipi

Systemic Tx

# pts

# pts achieving ≥1yr disease control*

Cytotoxic Therapy

11/80 (14%)

5/10 (50%)

Anti-PD-1/PD-L1

16/80 (20%)

11/15 (73%)

BRAF inhibitor

10/80 (13%)

7/9 (78%)

Ipi re-induction

18/80 (23%)

5/16 (31%)

Other clinical trial

13/80 (16%)

1/13 (8%)

*pts with ongoing disease control and <1yr follow up excluded

Conclusion

Within this single-institution cohort, the median OS and 2-yr OS were greater than reported previously in Phase III trials [1, 2]. Potential reasons for this survival advantage include: referral bias, heterogeneous Ipi dosing/schedule, and access to subsequent trials (i.e. anti-PD-1/PD-L1, BRAF inhibitor). The majority of long-term survivors required subsequent Tx, however prolonged disease control was achieved with a range of Tx's. Pts who experience oligometastatic/CNS-only progression following Ipi may achieve prolonged disease control with locoregional Tx alone.

Authors’ Affiliations

(1)
Memorial Sloan Kettering Cancer Center
(2)
Immune Monitoring Facility, Sloan Kettering Institute

References

  1. Hodi F, O'Day S, McDermott D: Improved Survival with Ipilimumab in patients with metastatic melanoma. N Engl J Med. 363: 711-23.Google Scholar
  2. Robert C, Thomas L, Bondarenko I: Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 364: 2517-26.Google Scholar

Copyright

© Page et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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