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THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS

BACKGROUND: Melanoma brain metastasis is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by...

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Autores principales: Sagar, Soumya, Lauko, Adam, Barnett, Addison, Wei, Wei, Chao, Samuel, Peereboom, David, Stevens, Glen, Angelov, Lilyana, Yu, Jennifer, Murphy, Erin, Mohammadi, Alireza, Suh, John, Barnett, Gene, Ahluwalia, Manmeet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213196/
http://dx.doi.org/10.1093/noajnl/vdz014.045
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author Sagar, Soumya
Lauko, Adam
Barnett, Addison
Wei, Wei
Chao, Samuel
Peereboom, David
Stevens, Glen
Angelov, Lilyana
Yu, Jennifer
Murphy, Erin
Mohammadi, Alireza
Suh, John
Barnett, Gene
Ahluwalia, Manmeet
author_facet Sagar, Soumya
Lauko, Adam
Barnett, Addison
Wei, Wei
Chao, Samuel
Peereboom, David
Stevens, Glen
Angelov, Lilyana
Yu, Jennifer
Murphy, Erin
Mohammadi, Alireza
Suh, John
Barnett, Gene
Ahluwalia, Manmeet
author_sort Sagar, Soumya
collection PubMed
description BACKGROUND: Melanoma brain metastasis is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by targeted therapy and immune checkpoint inhibitors (ICI). METHODS: 351 patients, who underwent treatment for MBM at our tertiary care center from 2000 to 2018, were grouped into those that received chemotherapy, ICI, or targeted therapy. Thirty-four percent of patients treated with ICI had received other systemic therapies as well as part of their management. OS was calculated from the date of diagnosis of the brain metastases. The Kaplan Meier analysis was utilized to determine median OS and difference in OS was determined by utilizing the Cox proportional hazard model. RESULTS: The median survival after the diagnosis of brain metastasis was 10.4, 11.96, and 7.06 months in patients who received ICI, chemotherapy and targeted therapy respectively. A multivariate model was developed including the type of systemic therapy, presence of extracranial metastases, age, KPS and number of intracranial lesions. 114 patients underwent SRS alone, 56 underwent SRS and WBRT, 43 underwent SRS and surgical removal, 28 had surgical removal, SRS and WBRT, and 78 had no intracranial therapy. Compared to patients who received chemotherapy, patients who received immunotherapy had a hazard ratio, HR = 0.628 (confidence interval = 0.396 – 0.994, p-value = 0.047). Presence of EC metastases (HR= 1.25, p-value < .001), lower KPS (HR = .97, p-value < .0001) and multiple brain lesions (HR = 1.117, p-value < .0001) were associated with significantly worse OS. CONCLUSIONS: Addition of ICI significantly improves the OS in MBM compared to chemotherapy. Lower performance status, multiple brain metastases, and EC metastases are associated with poor OS.
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spelling pubmed-72131962020-07-07 THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS Sagar, Soumya Lauko, Adam Barnett, Addison Wei, Wei Chao, Samuel Peereboom, David Stevens, Glen Angelov, Lilyana Yu, Jennifer Murphy, Erin Mohammadi, Alireza Suh, John Barnett, Gene Ahluwalia, Manmeet Neurooncol Adv Abstracts BACKGROUND: Melanoma brain metastasis is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by targeted therapy and immune checkpoint inhibitors (ICI). METHODS: 351 patients, who underwent treatment for MBM at our tertiary care center from 2000 to 2018, were grouped into those that received chemotherapy, ICI, or targeted therapy. Thirty-four percent of patients treated with ICI had received other systemic therapies as well as part of their management. OS was calculated from the date of diagnosis of the brain metastases. The Kaplan Meier analysis was utilized to determine median OS and difference in OS was determined by utilizing the Cox proportional hazard model. RESULTS: The median survival after the diagnosis of brain metastasis was 10.4, 11.96, and 7.06 months in patients who received ICI, chemotherapy and targeted therapy respectively. A multivariate model was developed including the type of systemic therapy, presence of extracranial metastases, age, KPS and number of intracranial lesions. 114 patients underwent SRS alone, 56 underwent SRS and WBRT, 43 underwent SRS and surgical removal, 28 had surgical removal, SRS and WBRT, and 78 had no intracranial therapy. Compared to patients who received chemotherapy, patients who received immunotherapy had a hazard ratio, HR = 0.628 (confidence interval = 0.396 – 0.994, p-value = 0.047). Presence of EC metastases (HR= 1.25, p-value < .001), lower KPS (HR = .97, p-value < .0001) and multiple brain lesions (HR = 1.117, p-value < .0001) were associated with significantly worse OS. CONCLUSIONS: Addition of ICI significantly improves the OS in MBM compared to chemotherapy. Lower performance status, multiple brain metastases, and EC metastases are associated with poor OS. Oxford University Press 2019-08-12 /pmc/articles/PMC7213196/ http://dx.doi.org/10.1093/noajnl/vdz014.045 Text en © The Author(s) 2019. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Sagar, Soumya
Lauko, Adam
Barnett, Addison
Wei, Wei
Chao, Samuel
Peereboom, David
Stevens, Glen
Angelov, Lilyana
Yu, Jennifer
Murphy, Erin
Mohammadi, Alireza
Suh, John
Barnett, Gene
Ahluwalia, Manmeet
THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS
title THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS
title_full THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS
title_fullStr THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS
title_full_unstemmed THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS
title_short THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS
title_sort ther-02. impact of systemic therapy in melanoma brain metastasis
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213196/
http://dx.doi.org/10.1093/noajnl/vdz014.045
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