In Neuro-oncology
BACKGROUD : Treatment options for patients with melanoma brain metastasis (MBM) have changed significantly in the last decade. Few studies have evaluated changes in outcomes and factors associated with survival in MBM patients over time. The aim of this study is to evaluate changes in clinical features and overall survival (OS) for MBM patients.
METHODS : Patients diagnosed with MBMs from 1/1/2009-12/31/2013 (Prior Era; PE) and 1/1/2014-12/31/2018 (Current Era; CE) at The University of Texas MD Anderson Cancer Center were included in this retrospective analysis. The primary outcome measure was OS. Log-rank test assessed differences between groups; multivariable analyses were performed with Cox proportional hazards models and recursive partitioning analysis (RPA).
RESULTS : 791 MBM patients (PE, n=332; CE, n=459) were included in analysis. Median OS from MBM diagnosis was 10.3 months (95% CI, 8.9 - 12.4) and improved in the CE versus PE (14.4 vs. 10.3 months, P < .001). Elevated serum LDH was the only factor associated with worse OS in both PE and CE patients. Factors associated with survival in CE MBM patients included patient age, primary tumor Breslow thickness, prior immunotherapy, leptomeningeal disease (LMD), symptomatic MBMs, and whole brain radiation therapy (WBRT). Several factors associated with OS in the PE were not significant in the CE. RPA demonstrated that elevated serum LDH and prior immunotherapy treatment are the most important determinants of survival in CE MBM patients.
CONCLUSIONS : OS and factors associated with OS have changed for MBM patients. This information can inform contemporary patient management and clinical investigations.
Hasanov Merve, Milton Denái R, Bea Davies Alicia, Sirmans Elizabeth, Saberian Chantal, Posada Eliza L, Opusunju Sylvia, Gershenwald Jeffrey E, Torres-Cabala Carlos A, Burton Elizabeth M, Colen Rivka, Huse Jason T, Glitza Oliva Isabella C, Chung Caroline, McAleer Mary Frances, McGovern Susan L, Yeboa Debra N, Kim Betty Y S, Prabhu Sujit S, McCutcheon Ian E, Weinberg Jeffrey, Lang Frederick F, Tawbi Hussein A, Li Jing, Haydu Lauren E, Davies Michael A, Ferguson Sherise D
2022-Dec-13
brain metastases, immunotherapy, leptomeningeal disease (LMD), melanoma
