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Poster display session

4306 - Characteristics of metastatic melanoma (MM) patients with leptomeningeal disease (LMD) and survival of > 1 year

Date

10 Sep 2017

Session

Poster display session

Presenters

Isabella Glitza

Citation

Annals of Oncology (2017) 28 (suppl_5): v428-v448. 10.1093/annonc/mdx377

Authors

I.C. Glitza1, J. Ma2, S.D. Ferguson3, R. Bassett Jr2, L. Haydu4, M.A. Davies1

Author affiliations

  • 1 Melanoma Medical Oncology, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 2 Department Of Biostatistics, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 3 Department Of Neurosurgery, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 4 Surgical Oncology, MD Anderson Cancer Center, 77030-4095 - Houston/US
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Resources

Abstract 4306

Background

Several studies have demonstrated that the presence of LMD correlates with very short overall survival (OS) in metastatic melanoma patients (pts). However, a subset of pts have OS > 12 months (mts). We reviewed the outcomes of a large cohort of patients with LMD to identity predictors of improved outcomes.

Methods

The clinical features, treatments, and OS of MM pts diagnosed with LMD by CSF cytology and/or radiographic findings from 2000 to 2015 were reviewed. Landmark Cox proportional hazard regression models were used to identify factors significantly associated with OS > 12 mts.

Results

178 pts with LMD were identified. For these, median age at diagnosis (dx) was 51.2 years, 62% were male, 75% pts had a performance status of ECOG 0-1, 39% had elevated LDH, extracranial disease present in 75% and concurrent brain metastasis in 77%. 56% of pts were tested for BRAF mutation, and 37% (of those tested?) were positive. 61% of pts had CSF analysis done, but 49% of these had positive cytology. Neurological deficits were reported in 49%. Median OS from LMD diagnosis was 4.27 mts (95%CI: 3.12-5.55), and 12-, 36-, and 60-mts cumulative OS was 0.22 (95%CI: 0.163-0.290), 0.11 (95%CI: 0.069-0.169), and 0.09 (95% CI: 0.054-0.151), respectively. Compared to those who died within 3 mts, pts who lived longer than 12 mts (n = 36) were more likely to have: ECOG of 0 (57.1% versus 15.3%), previous surgery (55.6% versus 25.3%), systemic disease controlled (41.7% versus 33.3), intrathecal therapy (69.4% versus 21.6%), systemic therapy with targeted therapy (55.6% versus 18.9%) or chemotherapy (61.1% versus 37.8%); and were less likely to have neurological deficits (27.8% versus 62.7%), previous systemic therapy (63.9% versus 88.0%), and LDH above normal (19.4% versus 45.9%). Positive CSF cytology (HR = 3.06, 95% CI 1.02-9.17) and concomitant systemic disease (HR = 2.65, 95%CI 1.03-6.82) were associated with significantly shorter OS.

Conclusions

Long term survival in MM pts with LMD is rare, but possible. Features significantly associated with OS may help strengthen the design and interpretation of future trials for pts with LMD.

Clinical trial identification

Legal entity responsible for the study

Isabella C Glitza

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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