Abstract
Novel medical therapies have revolutionized outcome for patients with melanoma. However, patients with melanoma brain metastases (MBM) still have poor survival. Data are limited as these patients are generally excluded from clinical trials, wherefore real-world data on clinical outcome may support evidence-based treatment choices for patients with MBM. Patients diagnosed with MBM between 2008 and 2020 were included retrospectively. Patient characteristics, treatment, and outcome data were recorded from The Danish Metastatic Melanoma Database, pathology registries, electronic patient files, and radiation plans. Anti-programmed cell death protein 1 antibodies and the combination of BRAF/MEK-inhibitors were introduced in Denmark in 2015, and the cohort was split accordingly for comparison. A total of 527 patients were identified; 148 underwent surgical excision of MBM, 167 had stereotactic radiosurgery (SRS), 270 received whole-brain radiation therapy (WBRT), and 343 received systemic therapies. Median overall survival (mOS) for patients diagnosed with MBM before and after 2015 was 4.4 and 7.6 months, respectively. Patients receiving surgical excision as first choice of treatment had the best mOS of 10.9 months, whereas patients receiving WBRT had the worst outcome (mOS, 3.4 months). Postoperative SRS did not improve survival or local control after surgical excision of brain metastases. Of the 40 patients alive >3 years after diagnosis of MBM, 80% received immunotherapy at some point after diagnosis. Patients with meningeal carcinosis did not benefit from treatment with CPI. Outcome for patients with MBM has significantly improved after 2015, but long-term survivors are rare. Most patients alive >3 years after diagnosis of MBM received immunotherapy.
Originalsprog | Engelsk |
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Tidsskrift | Melanoma Research |
Vol/bind | 32 |
Udgave nummer | 3 |
Sider (fra-til) | 173-182 |
Antal sider | 10 |
ISSN | 0960-8931 |
DOI | |
Status | Udgivet - 2022 |
Bibliografisk note
Funding Information:This work was supported by The Danish Cancer Society under Grant R288-A16117. The DAMMED is currently supported financially by MSD, BMS, Novartis, and Pierre Fabre without influencing data collection or results.
Funding Information:
M.D. has received honoraria for lectures from Roche. I.M.S. has received honoraria for consultancies and lectures from Novartis, Roche, Merck, and Bristol-Myers Squibb; a restricted research grant from Novartis; and financial support for attending symposia from Bristol-Myers Squibb, Merck, Novartis, Pfizer, and Roche. E.E. received honoraria from BMS, Pierre Fabre, Novartis for lectures, and travel/conference expenses from MSD. S.M. has received a research grant from Varian Medical Systems. G.P. has received research grants from Varian Medical Systems, honoraria for consultancies and lectures from Astra Zeneca, Bristol-Myers Squibb, Merck, Roche, and Takeda, financial support for attending symposia from Astra Zeneca, Bristol-Myers Squibb, Merck, Novartis, Pfizer, Pierre Fabre, Roche, and Takeda. All other authors declare that they have no conflicts of interest.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.