Abstract 1078P
Background
Novel medical therapies have revolutionized outcome for patients with melanoma. However, patients with melanoma brain metastases (MBM) still have a poor survival. Data are limited as these patients are generally excluded from clinical trials. Real-world data on changes in clinical outcome over time and efficacy data on treatment modalities could support more evidence-based treatment choices and determine overall benefit of modern therapies for patients with MBM.
Methods
Patients with MBM treated in the Capital Region of Denmark, between November 2008 and May 2020, were included retrospectively. Patient characteristics, treatment- and outcome data were collected from the Danish Metastatic Melanoma Database, pathology registries, electronic patient files and radiation plans. Targeted therapies and anti-PD1 antibodies were introduced in Denmark in 2015, and the cohort was split accordingly for comparison.
Results
A total of 527 patients with MBM were identified; 148 patients underwent surgical excision of MBM (14% surgery only), 167 patients had stereotactic radiosurgery (SRS) (14% SRS only), 270 patients whole brain radiation therapy (WBRT) (34% WBRT only) and 343 patients received systemic treatment (22% medical therapy only). The median overall survival (mOS) for patients diagnosed with MBM before and after 2015 was 4.5 and 7.4 months, respectively. For the entire cohort median intracranial progression free survival (icPFS) and mOS was 3.3 and 8.9 months for surgical excision, 3.1 and 7.1 months for SRS, 1.7 and 2.6 months for WBRT, and 4.2 and 6.6 months for 1st line systemic therapy after diagnosis of MBM. For patients treated with anti-PD1 plus anti-CTLA-4 12-months icPFS and OS was 48% and 54%, respectively, for anti-PD1 monotherapy 42% and 50%, and for BRAF/MEKi 11% and 33%. Of the 40 patients (7.6%) alive >3 years after diagnosis of MBM, 55% underwent surgical excision of MBM, 48% had SRS, 20% had WRBT and 80% received immunotherapy at some point after diagnosis.
Conclusions
Outcome for patients with MBM has significantly improved after 2015 but long-term survivors are rare. The majority of patients alive >3 years after diagnosis of MBM received immunotherapy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Danish Cancer Society.
Disclosure
S. Møller: Financial Interests, Institutional, Research Grant: Varian Medical Systems. M. Donia: Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Invited Speaker: Roche; Non-Financial Interests, Personal, Other, Sub-investigator of clinical trial with connected translational research: Bristol Myers Squibb. G.F. Persson: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Institutional, Other, Virtual Congress participation: BMS; Financial Interests, Institutional, Other, Virtual Congress participation: Pfizer; Non-Financial Interests, Institutional, Other, Local PI: Pierre Fabre; Non-Financial Interests, Institutional, Research Grant: Varian Medical Systems. I.M. Svane: Financial Interests, Personal, Invited Speaker: BMS; Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Writing Engagements: MSD; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Advisory Board: Pierre Fabre; Financial Interests, Personal, Invited Speaker: Pierre Fabre; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Stocks/Shares: IO Biotech; Non-Financial Interests, Institutional, Research Grant: Adaptimmune; Non-Financial Interests, Institutional, Research Grant: Enara Bio; Non-Financial Interests, Institutional, Funding: Evaxion; Non-Financial Interests, Institutional, Research Grant: Lytix Biopharma; Non-Financial Interests, Institutional, Research Grant: TILT Biotherapeutics; Non-Financial Interests, , Principal Investigator: BMS; Non-Financial Interests, , Principal Investigator: Lytix Biopharma; Non-Financial Interests, , Principal Investigator: Novartis; Non-Financial Interests, , Principal Investigator: Roche; Non-Financial Interests, , Principal Investigator: TILT Biotherapeutics. E. Ellebaek: Financial Interests, Personal, Invited Speaker: BMS; Financial Interests, Personal, Invited Speaker: Pierre Fabre; Financial Interests, Personal, Invited Speaker: Kyowa Kirin; Financial Interests, Personal, Other, Travel/conference expenses: MSD. All other authors have declared no conflicts of interest.