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Poster Display session 3

4550 - A multivariate model to define prognostic groups among patients with melanoma brain metastases: a 10-year retrospective cohort study

Date

30 Sep 2019

Session

Poster Display session 3

Presenters

Giacomo Pelizzari

Citation

Annals of Oncology (2019) 30 (suppl_5): v533-v563. 10.1093/annonc/mdz255

Authors

G. Pelizzari1, E. Bertoli2, M.G. Vitale2, S. Buriolla1, L. Palmero2, M. Bartoletti1, D. Zara2, D. Basile1, D. Iacono3, G. Pascoletti3, M. Cinausero3, E. Poletto3, S. Bolzonello4, A. Freschi4, F. Puglisi1, G. Fasola3, A.M. Minisini3

Author affiliations

  • 1 Department Of Medicine (dame), University Of Udine, Udine, Italy; Dipartimento Di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 - Aviano/IT
  • 2 Dipartimento Di Oncologia, Azienda Sanitaria Universitaria Integrata Di Udine, Udine, Italy; Department Of Medicine (dame), University of Udine, 33100 - Udine/IT
  • 3 Dipartimento Di Oncologia, Azienda Sanitaria Universitaria Integrata di Udine, 33100 - Udine/IT
  • 4 Dipartimento Di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 - Aviano/IT
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Resources

Abstract 4550

Background

Patients (pts) with melanoma brain metastases (BM) have a historically poor prognosis, with a reported median overall survival (mOS) of 4-6 months. Aim of this study is to evaluate predictive factors of survival in pts with melanoma BM. Secondly, a multivariate model was used to define groups with distinct prognosis.

Methods

Consecutive pts with melanoma BM treated in two Italian cancer centers were included in this 10-year retrospective cohort study (2008-2018). Baseline clinicopathological factors, systemic and loco-regional treatments were registered. The Kaplan-Meier method and the Cox model were used to analyze the association of prognostic factors and OS.

Results

150 pts with melanoma BM were enrolled in this study: 42% with a single BM, 51.3% with ≥ 3 extracranial metastatic sites and 38% with an ECOG performance status (PS) of 0. About 50.7% of pts had a BRAF mutation. Notably, 56% of pts were asymptomatic at BM diagnosis, and 40% presented high LDH levels at baseline. Overall, mOS after BM diagnosis was 5.78 months (95% CI 4.80-6.67), and median intracranial progression-free survival was 4.63 months (95% CI 3.81-5.12). According to treatment modality, stereotactic radiosurgery/neurosurgery plus systemic therapy showed the best outcome (mOS 12.32 months, 95% CI 7.92-25.30). A multivariate model was used to identify baseline prognostic factors independently associated with OS (Table). Conversely, sex and symptomatic BM did not significantly impact on OS. Predicted survival functions defined 3 distinct prognostic groups (P < 0.0001): favorable (≤ 2 points: mOS 8.47 months, 95% CI 7.52-12.71), intermediate (3 points: mOS 4.93 months, 95% CI 3.84-6.01), poor (≥ 4points: mOS 2.66 months, 95% CI 2.23-3.61).Table:

1363P

CovariatesHR95% CIPPoints
BRAF wild type1.951.22-3.12< 0.011
BM > 12.201.35-3.59< 0.011
LDH ≥ 2 x upper normal limit1.831.07-3.110.0261
ECOG PS > 02.681.62-4.430.00011
Extracranial metastatic sites ≥ 31.911.17-3.1< 0.011
Age ≥ 651.861.15-3.020.0121

Conclusions

This score can be useful for stratifying prognosis in pts with melanoma BM. Prospective studies are needed to validate this score and to explore how it may guide treatment strategy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Dipartimento di Oncologia, Azienda Sanitaria Universitaria Integrata di Udine.

Funding

Has not received any funding.

Disclosure

F. Puglisi: Honoraria (self), Advisory / Consultancy: Amgen; Advisory / Consultancy: Celgene; Advisory / Consultancy: Eisai; Advisory / Consultancy: Eli Lilly; Honoraria (self), Advisory / Consultancy: Ipsen; Honoraria (self), Research grant / Funding (self): Novartis; Advisory / Consultancy: Pfizer; Advisory / Consultancy, Research grant / Funding (self): Roche; Honoraria (self): Pierre Fabre; Advisory / Consultancy: Merck Sharp & Dohme; Advisory / Consultancy: Takeda; Research grant / Funding (self): Astrazeneca. All other authors have declared no conflicts of interest.

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