Impact of Novel Treatments in Patients with Melanoma Brain Metastasis: Real-World Data

• Published in: Cancers Vol. 15; no. 5; p. 1461
• Main Authors: Derks, Sophie H A E, Jongen, Joost L M, van der Meer, Edgar L, Ho, Li Shen, Slagter, Cleo, Joosse, Arjen, de Jonge, Maja J A, Schouten, Joost W, Oomen-de Hoop, Esther, van den Bent, Martin J, van der Veldt, Astrid A M
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 25.02.2023; MDPI
• Subjects: Cancer; Care and treatment; Chemotherapy; Clinical medicine; Diagnosis; Immune checkpoint inhibitors; Immunosuppressive agents; Melanoma; Metastases; Metastasis; Patients; Radiation therapy; Survival; Tomography; Netherlands; BRAF/MEK inhibitors; immunotherapy; survival; radiotherapy; brain neoplasms/metastasis; melanoma; molecular targeted therapy; immune checkpoint inhibitors
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15051461

Melanoma brain metastasis (MBM) is associated with poor outcome, but targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) have revolutionized treatment over the past decade. We assessed the impact of these treatments in a real-world setting. A single-center cohort study was performed at a large, tertiary referral center for melanoma (Erasmus MC, Rotterdam, the Netherlands). Overall survival (OS) was assessed before and after 2015, after which TTs and ICIs were increasingly prescribed. There were 430 patients with MBM included; 152 pre-2015 and 278 post-2015. Median OS improved from 4.4 to 6.9 months (HR 0.67, < 0.001) after 2015. TTs and ICIs prior to MBM diagnosis were associated with poorer median OS as compared to no prior systemic treatment (TTs: 2.0 vs. 10.9 and ICIs: 4.2 vs. 7.9 months, < 0.001). ICIs directly after MBM diagnosis were associated with improved median OS as compared to no direct ICIs (21.5 vs. 4.2 months, < 0.001). Stereotactic radiotherapy (SRT; HR 0.49, = 0.013) and ICIs (HR 0.32, < 0.001) were independently associated with improved OS. After 2015, OS significantly improved for patients with MBM, especially with SRT and ICIs. Demonstrating a large survival benefit, ICIs should be considered first after MBM diagnosis, if clinically feasible.