Correlation of Baseline Tumor Burden with Clinical Outcome in Melanoma Patients Treated with Ipilimumab

<b><i>Introduction:</i></b> Tumor burden is a frequently mentioned parameter; however, a commonly accepted definition is still lacking. <b><i>Methods:</i></b> In this double-center prospective and retrospective study, 76 patients with unresectable stage III or stage IV melanoma treated with ipilimumab were included. We defined the baseline tumor burden (BTB) as the global sum of all metastases’ longest diameters before treatment started and correlated the calculated BTB with disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and with the baseline levels of LDH, S100B, and sULPB2. <b><i>Results:</i></b> BTB correlated significantly with DCR (<i>p</i> = 0.009), PFS (<i>p</i> = 0.002), OS (<i>p</i> = 0.032), and the occurrence of NRAS mutation (<i>p</i> = 0.006). BTB was also correlated to baseline serum levels of LDH (<i>p</i> = 0.011), S100B (<i>p</i> = 0.027), and SULBP (<i>p</i> &lt; 0.0001). Multivariate analysis revealed that BPB and LDH were independently correlated with PFS and OS. With increasing BTB, disease control was less likely; no patient with a BTB &gt;200 mm achieved disease control. For patients with brain metastasis, no correlation of BTB with DCR (<i>p</i> = 0.251), PFS (<i>p</i> = 0.059), or OS (<i>p</i> = 0.981) was observed. <b><i>Conclusion:</i></b> Calculated BTB is an independent prognostic factor for patients with metastatic melanoma treated with ipilimumab. Using calculated BTB as a definition of tumor burden may help increase comparability of outcome of therapies in future studies.