Leptomeningeal disease from melanoma—Poor prognosis despite new therapeutic modalities

Chorti, Eleftheria; Kebir, Sied; Ahmed, M.; Keyvani, Kathy; Umutlu, Lale; Kanaki, Theodora; Zaremba, Anne; Reinboldt-Jockenhoefer, Finja; Knispel, Sarah; Gratsias, Emmanouil; Roesch, Alexander; Ugurel, Selma; Scheffler, Björn; Schadendorf, Dirk; Livingstone, Elisabeth; Meier, Friedegund; Glas, Martin; Zimmer, Lisa

doi:10.1016/j.ejca.2021.02.016

Cited by 20 publications

(19 citation statements)

References 41 publications

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“…BRAF mutational status was not correlated with OS, although this might be influenced by missing data. Surprisingly, LMD was not identified as a poor prognostic factor in multivariate analysis, although the presence of LMD is generally associated with an extremely poor prognosis [6,[23][24][25].…”

Section: Discussionmentioning

confidence: 87%

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Real-world data on melanoma brain metastases and survival outcome

et al. 2022

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Novel medical therapies have revolutionized outcome for patients with melanoma. However, patients with melanoma brain metastases (MBM) still have poor survival. Data are limited as these patients are generally excluded from clinical trials, wherefore real-world data on clinical outcome may support evidence-based treatment choices for patients with MBM. Patients diagnosed with MBM between 2008 and 2020 were included retrospectively. Patient characteristics, treatment, and outcome data were recorded from The Danish Metastatic Melanoma Database, pathology registries, electronic patient files, and radiation plans. Anti-programmed cell death protein 1 antibodies and the combination of BRAF/MEK-inhibitors were introduced in Denmark in 2015, and the cohort was split accordingly for comparison. A total of 527 patients were identified; 148 underwent surgical excision of MBM, 167 had stereotactic radiosurgery (SRS), 270 received whole-brain radiation therapy (WBRT), and 343 received systemic therapies. Median overall survival (mOS) for patients diagnosed with MBM before and after 2015 was 4.4 and 7.6 months, respectively. Patients receiving surgical excision as first choice of treatment had the best mOS of 10.9 months, whereas patients receiving WBRT had the worst outcome (mOS, 3.4 months). Postoperative SRS did not improve survival or local control after surgical excision of brain metastases. Of the 40 patients alive >3 years after diagnosis of MBM, 80% received immunotherapy at some point after diagnosis. Patients with meningeal carcinosis did not benefit from treatment with CPI. Outcome for patients with MBM has significantly improved after 2015, but long-term survivors are rare. Most patients alive >3 years after diagnosis of MBM received immunotherapy.

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Section: Discussionmentioning

confidence: 87%

“…Other recent retrospective analyses also reported that the prognosis for patients with LMD remained poor [23,24]; however, systemic therapies do improve OS [23]. Interestingly, CPI demonstrated poor efficacy in patients with LMD, whereas BRAF/MEKi seemed to improve the outcome for these patients.…”

Section: Discussionmentioning

confidence: 95%

Real-world data on melanoma brain metastases and survival outcome

et al. 2022

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“…2 Leptomeningeal metastases of melanoma have an extremely poor prognosis even with the use of BRAF inhibitors and immune checkpoint inhibitor immunotherapy. 3,4 In summary, we experienced a very rare case with meningeal melanocytosis. Although there are anecdotal case reports successfully treated with combination therapy with nivolumab and ipilimumab, 5 the patient did not respond to the treatment regimen.…”

Section: E T T E R T O T H E E D I T O R a Case Of Primary Meningeal ...mentioning

confidence: 89%

A case of primary meningeal melanocytosis treated with combination therapy with nivolumab and ipilimumab

Akatsuka

Toyama

Morimura

et al. 2022

The Journal of Dermatology

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“…This is important when assessing the available data, as patients who develop LMD while on targeted therapy continue to face a dismal prognosis ( 70 ). In addition, recent analyses of two large cohorts of patients confirmed that despite the use of targeted therapy, overall survival remained poor ( 76 , 77 ).…”

Section: Role Of Targeted Therapy In Lmdmentioning

confidence: 99%

Challenges and Advances in Diagnosis and Treatment of Leptomeningeal Disease (LMD)

2022

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Leptomeningeal disease (LMD) is a devastating category of CNS metastasis with a very poor prognosis and limited treatment options. With maximal aggressive therapy, survival times remain short and, without treatment, prognosis is measured in weeks. Both LMD diagnosis and treatment are challenging topics within neuro-oncology. In this review, we discuss the advances in LMD diagnosis with a focus on the role of circulating tumor DNA (ctDNA) and discuss the role of targeted and immunotherapy in LMD treatment.

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Leptomeningeal disease from melanoma—Poor prognosis despite new therapeutic modalities

Cited by 20 publications

References 41 publications

Real-world data on melanoma brain metastases and survival outcome

Real-world data on melanoma brain metastases and survival outcome

A case of primary meningeal melanocytosis treated with combination therapy with nivolumab and ipilimumab

Challenges and Advances in Diagnosis and Treatment of Leptomeningeal Disease (LMD)

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