Efficacy of immunotherapy for melanoma brain metastases in patients with concurrent corticosteroid exposure

AIM: Immune checkpoint inhibitor (ICI) efficacy is undefined for melanoma brain metastases (MBM) with concurrent corticosteroid exposure. MATERIALS & METHODS: We retrospectively evaluated patients with untreated MBM who received corticosteroids (≥1.5 mg dexamethasone equivalent) within 30 days of ICI. mRECIST criteria and Kaplan–Meier methods defined intracranial progression-free survival (iPFS). The lesion size-response association was evaluated with repeated measures modeling. RESULTS: A total of 109 MBM were evaluated. The patient level intracranial response rate was 41%. Median iPFS was 2.3 months and overall survival was 13.4 months. Larger lesions were more likely to progress, with diameter >2.05 cm most predictive of progression (OR: 18.9; 95% CI: 2.6–139.5; p = 0.004). There was no difference in iPFS with steroid exposure pre- versus post-ICI initiation. CONCLUSION: In the largest reported ICI+corticosteroid cohort, we identify size dependent MBM response.