Validation of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

Nieder, Carsten; Hintz, Mandy; Bilger, Angelika; Oehlke, Oliver; Grosu, Anca‐Ligia

doi:10.14740/jocmr3248w

Cited by 12 publications

(11 citation statements)

References 16 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the score did not take into account whether and what systemic treatment these patients received as background to local treatment. In the only study to date that validated the molGPA score, 70% of patients received WBRT and concurrent systemic therapy was likewise not recorded [18]. Other available scores have been shown to underestimate OS as these were all developed before widespread implementation of TT/IT [19].…”

Section: Introductionmentioning

confidence: 99%

Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy

et al. 2020

View full text Add to dashboard Cite

Background: Melanoma patients frequently develop brain metastases. The most widely used score to predict survival is the molGPA based on a mixed treatment of stereotactic radiotherapy (SRT) and whole brain radiotherapy (WBRT). In addition, systemic therapy was not considered. We therefore aimed to evaluate the performance of the molGPA score in patients homogeneously treated with SRT and concurrent targeted therapy or immunotherapy (TT/IT). Methods: This retrospective analysis is based on an international multicenter database (TOaSTT) of melanoma patients treated with TT/IT and concurrent (≤30 days) SRT for brain metastases between May 2011 and May 2018. Overall survival (OS) was studied using Kaplan-Meier survival curves and log-rank testing. Uni-and multivariate analysis was performed to analyze prognostic factors for OS. Results: One hundred ten patients were analyzed. 61, 31 and 8% were treated with IT, TT and with a simultaneous combination, respectively. A median of two brain metastases were treated per patient. After a median follow-up of 8 months, median OS was 8.4 months (0-40 months). The molGPA score was not associated with OS. Instead, cumulative brain metastases volume, timing of metastases (syn-vs. metachronous) and systemic therapy with concurrent IT vs. TT influenced OS significantly. Based on these parameters, the VTS score (volume-timing-systemic therapy) was established that stratified patients into three groups with a median OS of 5.1, 18.9 and 34.5 months, respectively (p = 0.001 and 0.03).

show abstract

Section: Introductionmentioning

confidence: 99%

Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Limitations of this study, which followed the methods used in previous validation studies [15,16], include the small number of patients, which were recruited over a long period of more than 10 years, statistical power of subgroup analyses, and retrospective design. Given that patients managed with best supportive care were excluded, worse survival outcomes could be expected if one would analyze all patients with a brain metastasis diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic treatment before and after brain-directed measures was usually prescribed as judged appropriate by the patients' medical oncologists. The patients (allcomers) were treated consecutively between 2005 and 2018 and identified from a previously described database [15][16][17], which includes data from the radiotherapy centers in Bodø and Freiburg. Prognosis was estimated on the basis of age, KPS, extracranial metastases and number of brain metastases as described in the recent GI-GPA publication [1] and shown in Table 1.…”

Section: Patients and Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Validation of the graded prognostic assessment for gastrointestinal cancers with brain metastases (GI-GPA)

et al. 2020

Self Cite

View full text Add to dashboard Cite

Purpose: The purpose of this study was to validate a new prognostic model (GI-GPA) originally derived from a multi-center database (USA, Canada, Japan). Patients and Methods: This retrospective study included 92 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy. Information about age, extracranial spread, number of brain metastases, performance status and other variables was collected. The GI-GPA score was calculated as described by Sperduto et al. Results: Median survival was 4 months. The corresponding figures for the 4 different prognostic strata were 2.3, 4.4, 9.4 and 12.7 months, respectively (p = 0.0001). Patients whose management included surgical resection had longer median survival than those who were treated with other approaches (median 11.9 versus 3.0 months, p = 0.002). Comparable results were seen for additional systemic therapy (median 8.5 versus 3.5 months, p = 0.01). Conclusion: These results confirm the validity of the GI-GPA in an independent dataset from a different geographical region, despite the fact that overall survival was shorter in all prognostic strata, compared to Sperduto et al. Potential explanations include differences in molecular tumor characteristics and treatment selection, both brain metastasesdirected and extracranially. Long-term survival beyond 5 years is possible in a small minority of patients.

show abstract

“…In contrast, development of distant brain failure often results in need for further SRS or WBRT (9,10). Besides local brain control, a variety of other factors that can be combined in prognostic scores are crucial determinants of long-term survival (5,6,8,16,17).…”

Section: Discussionmentioning

confidence: 99%

Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases

Nieder

Yobuta

Mannsåker

2018

In Vivo

Self Cite

View full text Add to dashboard Cite

Background/Aim: The aim of this study was to analyze the patterns of treatment and outcomes in patients with a large number of brain metastases, arbitrarily defined as 20 or more lesions. These patients are typically excluded from studies of focal brain treatment, e.g., surgery or radiosurgery, and might have a limited prognosis. Patients and Methods: This was a retrospective single-institution analysis. Overall, 11 patients were identified from a prospectively maintained database. Results: Ten patients had received active treatment (9 whole-brain radiotherapy, 7 systemic therapy). Median survival was 5.0 months without long-term survival beyond 13 months. Patients with better performance status had numerically longer survival, however we did not identify baseline parameters with a significant impact on survival. Conclusion: While long-term survival was not observed in this small study, most patients survived long enough to experience symptomatic improvement from whole-brain radiotherapy. Therefore, we recommend multidisciplinary assessment of the patients' prognosis and systemic treatment options, and initiation of whole-brain radiotherapy if survival is not limited to 1-2 months. Advances in diagnostic imaging have facilitated detection of small intracranial lesions (1-3) and thus resulted in decreasing numbers of patients who present with 1-3 brain metastases from solid extracranial primary tumors, e.g., lung, breast, kidney cancer or malignant melanoma (4). Many patients with 1-3 brain metastases are considered adequate candidates for surgery and/or radiosurgery (SRS) (5-8). Technically, it is also 173 This article is freely accessible online.

show abstract

Validation of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

Cited by 12 publications

References 16 publications

Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy

Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy

Validation of the graded prognostic assessment for gastrointestinal cancers with brain metastases (GI-GPA)

Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases

Contact Info

Product

Resources

About