Estimating Survival in Melanoma Patients With Brain Metastases: An Update of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

Sperduto, Paul W.; Jiang, Wen; Brown, Paul D.; Braunstein, Steve; Sneed, Penny K.; Wattson, Daniel A.; Shih, Helen A.; Bangdiwala, Ananta S; Shanley, Ryan; Lockney, Natalie A.; Beal, Kathryn; Lou, Emil; Amatruda, Thomas T.; Sperduto, William; Kirkpatrick, John P.; Yeh, Norman; Gaspar, Laurie E.; Molitoris, Jason K.; Masucci, Laura; Roberge, David; Yu, James B.; Chiang, Veronica; Mehta, Minesh P.

doi:10.1016/j.ijrobp.2017.06.2454

Cited by 170 publications

(167 citation statements)

References 15 publications

(19 reference statements)

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“…The well-known problem of these scoring systems is their limited ability to predict an individual patient's prognosis. Even the most recent scores, such as the lung and melanoma molGPA [20,21], which integrate molecular features, include several long-term survivors in the group with unfavorable prognosis, and early deaths in the two more favorable groups.…”

Section: Discussionmentioning

confidence: 99%

External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

2020

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KeywordsBrain metastases · Radiotherapy · Prognostic score · Graded prognostic assessment · Lactate dehydrogenase Abstract Purpose: The aim of our study was the external validation of an extended variant of the four-tiered diagnosis-specific graded prognostic assessment (DS-GPA) that includes more information about extracranial disease burden and blood test results, and predicts survival of patients with brain metastases. The extracranial DS-GPA (EC-GPA) includes serum albumin, lactate dehydrogenase, and number of extracranial organs involved. Originally, the score was developed in Germany. Patients and Methods: A retrospective analysis of 236 patients with brain metastases treated with primary whole-brain radiotherapy in North-Norway was performed (independent external validation cohort). Results: The fourtiered EC-GPA score showed good discrimination between all prognostic groups (log-rank test p < 0.05 for all pairwise comparisons). One-year survival was 0, 11, 30, and 100%, respectively. Median survival was 0.7 months (95% CI, 0.5-0.9) in the worst prognostic group, with a hazard ratio for death of 44.31 (95% CI, 5.78-339.50) compared to the best group. In the German database, the corresponding HR was 31.64 (median survival 0.4 months). The remaining hazard ratios in this validation study were 7.13 and 12.10, compared with 4.84 and 9.26 in the score development study. Conclusions:This study provides an independent validation of the EC-GPA, which was the best prognostic model for defining patients who did not benefit from radiation therapy of brain metastases in terms of overall survival in the original German study. The proposed modification of the established DS-GPA should undergo further validation in multi-institutional databases.

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Section: Discussionmentioning

confidence: 99%

External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

2020

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“…According to clinical and imaging data, central nervous system (CNS) metastases were found in 2-20% of patients and in 36-54% of cases according to autopsy studies [1]. The median overall survival for patients with melanoma brain metastases is 9.8 months [2]. Several treatments have been shown to significantly improve the life expectancy in these patients.…”

Section: Introductionmentioning

confidence: 99%

Advanced Survival in Patients with Multiple Irradiations for Brain Melanoma Metastases and Associated Abscopal Effect

Galkin¹,

Golanov²,

Ветлова³

et al. 2018

Cureus

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“…Several prognostic indices exist for patients with BMs, which evolved from a recursive partitioning analysis that divided patients into 3 prognostic classes based on performance status (PS), extent/control of extracranial disease, and age to the graded prognostic analysis (GPA) by adding the number of BMs. Next, diagnosis‐specific GPAs for lung, melanoma, renal cell, breast, and gastrointestinal cancers were created; and, finally, molecular markers were added to develop molecular GPAs for non–small‐cell lung cancer (NSCLC) and melanoma . Although the clinical value of these tools has been limited and overall performance status tends to drive clinical management, they serve to better educate the patient and enable a more informed understanding of the potential risks and benefits of the various treatment modalities.…”

Section: Prognostic Assessmentmentioning

confidence: 99%

“…Next, diagnosis-specific GPAs for lung, melanoma, renal cell, breast, and gastrointestinal cancers were created; and, finally, molecular markers were added to develop molecular GPAs for non-small-cell lung cancer (NSCLC) and melanoma. 14,15 Although the clinical value of these tools has been limited and overall performance status tends to drive clinical management, they serve to better educate the patient and enable a more informed understanding of the potential risks and benefits of the various treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Current multidisciplinary management of brain metastases

Moravan

Fecci

Anders

et al. 2020

Cancer

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Brain metastasis (BM), the most common adult brain tumor, develops in 20% to 40% of patients with late‐stage cancer and traditionally are associated with a poor prognosis. The management of patients with BM has become increasingly complex because of new and emerging systemic therapies and advancements in radiation oncology and neurosurgery. Current therapies include stereotactic radiosurgery, whole‐brain radiation therapy, surgical resection, laser‐interstitial thermal therapy, systemic cytotoxic chemotherapy, targeted agents, and immune‐checkpoint inhibitors. Determining the optimal treatment for a specific patient has become increasingly individualized, emphasizing the need for multidisciplinary discussions of patients with BM. Recognizing and addressing the sequelae of BMs and their treatment while maintaining quality of life and neurocognition is especially important because survival for patients with BMs has improved. The authors present current and emerging treatment options for patients with BM and suggest approaches for managing sequelae and disease recurrence.

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Estimating Survival in Melanoma Patients With Brain Metastases: An Update of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

Cited by 170 publications

References 15 publications

External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

Advanced Survival in Patients with Multiple Irradiations for Brain Melanoma Metastases and Associated Abscopal Effect

Current multidisciplinary management of brain metastases

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