CheckMate 204 Update: Practice-Changing for Brain Metastases?

Source: Medscape, October 2019

I am Jeffrey Weber, a medical oncologist at the Laura and Isaac Perlmutter Cancer Center at NYU Langone Health in New York City.

An important abstract presented at the 2019 American Society of Clinical Oncology (ASCO) meeting reported an update of the CheckMate 204 study,[1] a phase 2 trial of ipilimumab 3 mg/kg plus nivolumab 1 mg/kg induction therapy given to patients who had melanoma and previously untreated brain metastases. The initial CheckMate 204 study was published in 2018 in the New England Journal of Medicine.[2]

Patients in this phase 2 study predominantly had one to two brain metastases with a median tumor diameter of about 15 mm. Again, all of these metastases were previously untreated. This update included a cohort of 101 asymptomatic patients with a median follow-up of 20.6 months. The patients were relatively typical melanoma patients with an average age of 59 years. About 40% had LDH levels above the upper limit of normal. And they had a 50/50 spread of PD-L1 positivity and negativity; 78% had one to two metastases and 22% had three or more.

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