Full text

Turn on search term navigation

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Simple Summary

Brain metastases are common in melanoma and are often associated with significant morbidity and mortality. Although many new treatments for melanoma have been approved in recent years, including immune checkpoint inhibitors and BRAF/MEK inhibitors, limited data are available for survival for patients with brain metastases treated with these novel therapies. The aim of this retrospective study was to evaluate current surgical, radiation, and systemic therapies over the past 10 years in melanoma patients with brain metastases. Our study noted increased overall survival in patients treated with craniotomy and CTLA-4 checkpoint inhibitors, while whole brain radiation was associated with poorer overall survival.

Abstract

Brain metastases commonly develop in melanoma and are associated with poor overall survival of about five to nine months. Fortunately, new therapies, including immune checkpoint inhibitors and BRAF/MEK inhibitors, have been developed. The aim of this study was to identify outcomes of different treatment strategies in patients with melanoma brain metastases in the era of checkpoint inhibitors. Patients with brain metastases secondary to melanoma were identified at a single institution. Univariate and multivariable analyses were performed to identify baseline and treatment factors, which correlated with progression-free and overall survival. A total of 209 patients with melanoma brain metastases were identified. The median overall survival of the cohort was 5.3 months. On multivariable analysis, the presence of non-cranial metastatic disease, poor performance status (ECOG 2–4), whole-brain radiation therapy, and older age at diagnosis of brain metastasis were associated with poorer overall survival. Craniotomy (HR 0.66, 95% CI 0.45–0.97) and treatment with a CTLA-4 checkpoint inhibitor (HR 0.55, 95% CI 0.32–0.94) were the only interventions associated with improved overall survival. Further studies with novel agents are needed to extend lifespan in patients with brain metastases in melanoma.

Details

Title
Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy
Author
Rieth, John M 1   VIAFID ORCID Logo  ; Swami, Umang 2   VIAFID ORCID Logo  ; Mott, Sarah L 3 ; Zanaty, Mario 4 ; Henry, Michael D 5 ; Bossler, Aaron D 6   VIAFID ORCID Logo  ; Greenlee, Jeremy D 4 ; Zakharia, Yousef 3   VIAFID ORCID Logo  ; Vanneste, Marion 5 ; Jennings, Brooke 5   VIAFID ORCID Logo  ; Milhem, Mohammed M 3 

 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA 
 Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT 84112, USA; [email protected] 
 Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; [email protected] (S.L.M.); [email protected] (Y.Z.); [email protected] (M.M.M.) 
 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; [email protected] (M.Z.); [email protected] (J.D.G.) 
 Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; [email protected] (M.D.H.); [email protected] (M.V.); [email protected] (B.J.) 
 Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; [email protected] 
First page
1489
Publication year
2021
Publication date
2021
Publisher
MDPI AG
e-ISSN
20726694
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2547521655
Copyright
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.