Survival and prognostic factors for patients with melanoma brain metastases in the era of modern systemic therapy

Tio, Martin; Wang, Xuan; Carlino, Matteo S.; Shivalingam, Brindha; Fogarty, Gerald B; Guminski, Alexander; Lo, Serigne; Hong, Angela; Menzies, Alexander M.; Long, Georgina V.

doi:10.1111/pcmr.12682

Cited by 36 publications

(21 citation statements)

References 38 publications

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“…In the past, median survival for patients with newly diagnosed brain metastases was 2 -6 months [1]. Retrospective analyses indicate a survival benefit under multimodal therapy with a 5-year survival rate of more than 20 % [1]. We report on a 50-year-old patient with multiple symptomatic brain metastases at initial diagnosis.…”

Section: Introductionmentioning

confidence: 92%

“…However, brain metastases continue to pose a therapeutic challenge. In the past, median survival for patients with newly diagnosed brain metastases was 2 -6 months [1]. Retrospective analyses indicate a survival benefit under multimodal therapy with a 5-year survival rate of more than 20 % [1].…”

Section: Introductionmentioning

confidence: 99%

“…Hirnmetastasen stellen jedoch weiterhin eine therapeutische Herausforderung dar. In der Vergangenheit lag das mediane Überleben für Patienten mit neu diagnostizierten Hirnmetastasen bei 2 -6 Monaten [1]. Retrospektive Analysen sprechen für einen Überlebensbenefit unter multimodaler Therapie mit einer 5-Jahres-Überlebensrate von über 20 % [1].…”

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“…In der Vergangenheit lag das mediane Überleben für Patienten mit neu diagnostizierten Hirnmetastasen bei 2 -6 Monaten [1]. Retrospektive Analysen sprechen für einen Überlebensbenefit unter multimodaler Therapie mit einer 5-Jahres-Überlebensrate von über 20 % [1]. Wir berichten über einen 50-jährigen Patienten mit multiplen symptomatischen Hirnmetastasen bei Erstdiagnose.…”

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Multimodiale Therapie von Hirnmetastasen

Ahmed

Meier

Beissert

2020

Aktuelle Dermatologie

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ZusammenfassungDas Langzeitüberleben hat sich für Patienten mit metastasiertem Melanom durch die Etablierung der zielgerichteten Therapien sowie Immuntherapien mit 5-Jahres-Überlebensraten von ca. 50 % deutlich verbessert. Hirnmetastasen stellen jedoch weiterhin eine therapeutische Herausforderung dar. In der Vergangenheit lag das mediane Überleben für Patienten mit neu diagnostizierten Hirnmetastasen bei 2 – 6 Monaten 1. Retrospektive Analysen sprechen für einen Überlebensbenefit unter multimodaler Therapie mit einer 5-Jahres-Überlebensrate von über 20 % 1.Wir berichten über einen 50-jährigen Patienten mit multiplen symptomatischen Hirnmetastasen bei Erstdiagnose. Nach Exstirpation einer symptomatischen Metastase wurde bei BRAF-V600E-Mutation eine Systemtherapie mit dem BRAF-Inhibitor Dabrafenib in Kombination mit dem MEK-Inhibitor Trametinib eingeleitet. Hierunter zeigte sich ein rascher deutlicher Regress der zerebralen und extrazerebralen Metastasen. Nach 8 Wochen wurde die Systemtherapie auf eine Immuntherapie mit Nivolumab plus Ipilimumab umgesetzt. Kurz nach Therapieeinleitung trat ein epileptischer Anfall auf und die Hirnmetastasen zeigten sich wieder progredient. Zwei symptomatische Hirnmetastasen wurden reseziert, eine Ganzhirnradiatio mit Hippocampusschonung wurde eingeleitet und die Immuntherapie fortgesetzt. Aktuell erfolgt eine zielgerichtete Therapie mit Encorafenib und Binimetinib. 17 Monate nach Erstdiagnose befindet sich der Patient in gutem Allgemeinzustand ohne neurologische Defizite. Dieser Fallbericht bestätigt den retrospektiv beobachteten Überlebensbenefit für Patienten mit Hirnmetastasen unter multimodaler Therapie.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Multimodiale Therapie von Hirnmetastasen

Ahmed

Meier

Beissert

2020

Aktuelle Dermatologie

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“…The median OS (overall survival) from diagnosis of BM was only 4-6 months in unselected patients (10)(11)(12)(13). The survival of patients with BM undergoing surgery and/or radiotherapy only slightly improved, with a median OS of 6.4-10.8 months (10,(12)(13)(14). Although targeted therapy using BRAF/MEK inhibitors has dramatically changed the prognosis of patients with metastatic melanoma (15), patients with BM who received targeted therapy did not have a significant improvement in survival, with a median OS of 7-9.6 months (16,17).…”

Section: Introductionmentioning

confidence: 99%

Survival Benefits of Anti-PD-1 Therapy in Combination With Radiotherapy in Chinese Melanoma Patients With Brain Metastasis

Yuan

Chen

et al. 2021

Front. Oncol.

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Limited data reported the synergistic anti-tumor effect of anti-PD-1 (programmed death 1) therapy and radiotherapy on melanoma BM (brain metastasis). And the efficacy in the Chinese population is unclear. This study aimed to evaluate the efficacy of anti-PD-1 therapy and radiotherapy in Chinese melanoma patients with BM. We retrospectively reviewed 96 consecutive melanoma patients with BM treated at Sun Yat-Sen University Cancer Center. Patient demographics, BM characteristics and treatment details were carefully collected. The intracranial PFS (progression free survival) and OS (overall survival) were estimated using the Kaplan-Meier method. Twenty-five patients were treated with anti-PD-1 therapy and radiotherapy. Eighteen (72.0%) patients had SBRT (stereotactic body radiation therapy) or SRS (stereotactic radiosurgery) for BM, 1 (4.0%) patient had WBRT (whole brain radiation therapy), 6 (24.0%) patients had SBRT/SRS and WBRT. The median treatment period of anti-PD-1 therapy was 10.77 months. Objective intracranial response was observed in 15 (60%) patients, and 5 (20%) patients achieved CR (complete response). After a median follow-up of 16 months, 11 (44%) patients experienced intracranial PD (progressive disease), and 15 (60%) patients died. The median intracranial PFS and OS were 10.73 months (range, 1.67–38.83 months) and 15.87 months (range, 2.47–41.50 months), respectively. The 1-year intracranial PFS and OS were 61.9% (95% CI, 44.1–86.9%) and 62.5% (95%CI, 45.8–85.2%), respectively. Patients with BM can benefit from a combination of anti-PD-1 therapy and radiotherapy. It merits further investigation in melanoma patients with BM.

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Treatment patterns and clinical outcomes for patients with melanoma and central nervous system metastases: A real‐world study

Tawbi

To²,

Bartley³

et al. 2021

Cancer Medicine

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Background:Patients with melanoma and central nervous system (CNS) metastases have poor survival outcomes. We investigated real-world treatment patterns and overall survival (OS) of patients with melanoma and CNS metastases. Methods:A retrospective analysis utilizing a nationwide de-identified electronic health record-derived database was undertaken in patients diagnosed with advanced melanoma between January 2011 and September 2018. Patients with any visit ≤90 days of metastatic diagnosis and with confirmed CNS metastases were included. Results:Of 3473 patients diagnosed with advanced melanoma, 791 patients with confirmed CNS metastases were identified and included in this analysis.Synchronous CNS metastasis (≤30 days of metastatic diagnosis) was associated with longer median OS than metachronous CNS metastasis (>30 days after metastatic diagnosis, 0.58 vs 0.42 years). Stereotactic radiosurgery (SRS) was the most common treatment (40.5%) alone or in combination with other local or systemic therapies, being more frequent in patients diagnosed in 2015+ versus 2011-2014 (44.1% vs 35.5%, respectively). The most common systemic treatment was immune checkpoint inhibitors (ICIs; 30.5%), predominantly anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) alone (2011-2014) and anti-programmed death-1 alone or in combination with anti-CTLA-4 (2015+). Median OS was longest in SRS-treated patients (1.17 years) regardless of number of CNS metastases. Median OS for SRStreated patients increased from 0.83 years (2011-2014) to 1.75 years (2015+). In multivariable analysis, the effect of SRS remained significant after adjustment for sex, race, intracranial and extracranial disease burden, and timing of CNS metastases. Interaction testing to examine potential synergy between SRS/whole-brain radiation therapy and ICIs found no significant interaction.

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Survival and prognostic factors for patients with melanoma brain metastases in the era of modern systemic therapy

Cited by 36 publications

References 38 publications

Multimodiale Therapie von Hirnmetastasen

Multimodiale Therapie von Hirnmetastasen

Survival Benefits of Anti-PD-1 Therapy in Combination With Radiotherapy in Chinese Melanoma Patients With Brain Metastasis

Treatment patterns and clinical outcomes for patients with melanoma and central nervous system metastases: A real‐world study

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