Abstract 3175
Background
The risk of brain metastases (BM) in advanced melanoma (MM) is 40-50%. Historical median survival of MM patients (pts) with BMs was 4-5 months. Current systemic treatments with targeted therapy and immunotherapy prolong survival up to > 2 years, while prognosis of BMs carrying pts is not fully defined and optimal treatment sequencing remain unknown. We aimed to analyze the contemporary treatment outcomes in this specific group of pts.
Methods
Clinical data, course of treatment and clinical outcomes of 376 subsequent stage IV melanoma patients with BMs treated in one reference institution in period 2000-2018 were analyzed retrospectively (39% of BMs pts diagnosed before 2014).
Results
Median age for BMS diagnosis was 61, 171 pts were BRAF+ and 118 - wild-type. Median time to BMs from melanoma diagnosis was 2.3 years (8% had BMs at diagnosis). In 1st line BRAF(-) pts were treated with anti-PD-1 in 36%, chemotherapy - 46%, while BRAF(+) pts – with BRAFi/MEKi - 68% and anti-PD-1 - 5%. For the whole group median overall survival (mOS) of BRAF(+) was 7 months, while mOS BRAF(-) - 4 m. mOS for patients treated initially with BRAFi/MEKi was 9 m, while for anti-PD1 - 15 m (but it may be related to less advanced cases preferred for immunotherapy). BMs treatment modality chosen primarily was neurosurgery in 78 (21%) pts, radiotherapy - 270 (72%) with increasing use of stereotactic radiosurgery in recent years, only systemic treatment was offered to 25 (7%) pts. OS was highly affected by the number of BMs, LDH and albumin level and GPA (Graded Prognostic Assessment) scale (all p < 0.0001). mOS for pts with 1 BM was 10 months, for 2-3 – 7.4 m and for 4+ - 3.6 months. mOS was the longest for pts treated with local therapy (SRS/neurosurgery) combined with immunotherapy. We found significant improvement in OS for BM pts treated after 2013 (p < 0.0001) especially with GPA score 3 or 4 (p < 0.05) - 24-month OS rate 9% vs 28% for pts diagnosed since 2014.
Conclusions
The outcomes of patients with BMs is highly improved when local therapy (neurosurgery +/- SRS) is combined with modern systemic therapy. The introduction of new therapies significantly improved survival of melanoma pts with BMs.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland.
Funding
Has not received any funding.
Disclosure
I. Lugowska: Honoraria (self), Research grant / Funding (institution): Roche; Honoraria (self): BMS. H. Kosela-Paterczyk: Honoraria (self): Novartis; Honoraria (self): BMS.A.M. Czarnecka: Honoraria (self), Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: BMS; Honoraria (self), Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Novartis. P. Rutkowski: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): BMS; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: MSD; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Novartis; Honoraria (self): Roche; Honoraria (self): Amgen; Speaker Bureau / Expert testimony: Eli Lilly; Advisory / Consultancy: Blueprint Medicines; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Pierre Fabre. All other authors have declared no conflicts of interest.
Resources from the same session
4021 - Prospective pathological experience with research biopsies in the context of clinical trials at Vall d’Hebron Institute of Oncology
Presenter: Paolo Nuciforo
Session: Poster Display session 3
Resources:
Abstract
5603 - Development of a comprehensive next-generation targeted sequencing assay for detection of gene-fusions in solid tumors
Presenter: Vinay Mittal
Session: Poster Display session 3
Resources:
Abstract
4952 - Next-generation sequencing for better treatment strategy of cancer of unknown primary (CUP)
Presenter: Kang Kook Lee
Session: Poster Display session 3
Resources:
Abstract
4590 - Circulating-free DNA analysis from long-term surviving metastatic colorectal cancer patients undergoing surgery for resectable disease.
Presenter: Michele Ghidini
Session: Poster Display session 3
Resources:
Abstract
3696 - Ultra-sensitive detection of circulating tumor DNA identifies patients in high risk of recurrence in early stages melanoma
Presenter: Filip Janku
Session: Poster Display session 3
Resources:
Abstract
4295 - Identification of the founder BRCA1 mutation c.4117G>T (p.Glu1373*) recurring in Abruzzo and Lazio regions of Central Italy and predisposing to breast/ovarian and BRCA1-related cancers
Presenter: Daniela Di Giacomo
Session: Poster Display session 3
Resources:
Abstract
2214 - Enzalutamide (ENZA) and Apalutamide (APA) In vitro chemical reactivity studies and Activity in a Mouse Drug Allergy Model (MDAM)
Presenter: Mausumee Guha
Session: Poster Display session 3
Resources:
Abstract
5044 - Influence of genetic variation in COMT on cisplatin-induced nephrotoxicity in cancer patients.
Presenter: Bram Agema
Session: Poster Display session 3
Resources:
Abstract
3293 - Cardioprotective and anti-inflammatory effects of Empagliflozin during treatment with Doxorubicin: a cellular and preclinical study
Presenter: Vincenzo Quagliariello
Session: Poster Display session 3
Resources:
Abstract
3324 - Breast Cancer Organoids Model Treatment Response of HER2 Targeted Therapy in HER2-mutant Breast Cancer
Presenter: Xuelu Li
Session: Poster Display session 3
Resources:
Abstract