Survival in Melanoma Brain Metastases in the era of novel systemic therapies: aggressive approach supported
November 2, 2020
Abstract
Background:
Melanoma brain metastases (MBM) have historically poor overall survival (OS). Recently introduced systemic anticancer therapies (SACT), namely targeted therapies (TT) such as BRAF inhibitors and immunotherapy (IO), to control advanced disease have shown improved survival. Today, increasingly aggressive strategies are sought for MBM. We review outcomes in MBM after surgery or stereotactic radiosurgery (SRS) and the survival impact in advanced systemic disease when combined with novel anticancer therapies.
Methods:
Retrospective cohort study of patients referred to a regional neuro-oncology multidisciplinary (MDT) meeting with MBM. Demographic data, extent of systemic disease and data on surgical and oncological management were collected, plus use of SACT. The primary outcomes were median OS, 12 and 24 month survival and progression-free survival.
Results:
Between 2010 – 2018 142 patients with MBM were referred. Following the introduction of SACT the rate of referrals to MDT more than doubled from 11.6 to 25.7 patients per year. A focal brain metastasis was treated surgically in 23 (16.2%) patients, and by SRS in 29 (20.4%). 56 (39.4%) patients underwent palliative whole brain radiotherapy (WBRT) and 34 (23.9%) did not receive treatment. Median OS was 11 months for the surgical cohort, 9 months for the SRS cohort and increased when treatment with or without SACT was considered to 23 months and 12 months respectively.
Conclusion:
In the setting of SACTs, survival in MBM is significantly improved after surgery or SRS even in patients with advanced and uncontrolled systemic disease at the time of presentation, supporting an aggressive approach to MBM management.
Source:
Joseph P Merola, Joanita Ocen, Satish Kumar, James Powell, Caroline Hayhurst, Survival in Melanoma Brain Metastases in the era of novel systemic therapies, Neuro-Oncology Advances, , vdaa144, https://doi.org/10.1093/noajnl/vdaa144