Melanoma Advances Improved OS in Patients With Brain Mets

Sharon Worcester

July 20, 2020

Advances that emerged from 2007 – 2016 in the treatment of melanoma, including targeted agents, immunotherapy, and new radiotherapy techniques, led to significant improvement in overall survival for patients with melanoma and brain metastases, according to findings from a large population-based cohort study.

The 2-year survival rate doubled during that period, the researchers note: it was 13.8% for patients treated from 2013 – 2016, compared to 6.4% for patients treated from 2007 – 2009 (adjusted hazard ratio for the 2-year survival comparison, 0.65).

The study included 1096 melanoma patients who underwent radiotherapy, surgical excision, or both for brain metastases in Ontario, Canada, between January 1, 2007, and June 30, 2016.

During the study period, there was "a substantial increase in the use of new therapeutic agents," the authors note.

In initial period, from 2007 – 2009, only eight patients (2.5%) received BRAF and MEK inhibitors or immunotherapies, compared with 247 patients (53.7%) in the period from 2013 – 2016.

The study also showed that use of whole-brain radiotherapy (WBRT) decreased from 75.5% the period 2007 – 2009 to 52.0% in the period 2013 – 2016 (P < .001).

At the same time, the percentage of patients who initially received partial-brain radiotherapy techniques, such as gamma knife stereotactic radiosurgery, three-field intensity-modulated radiotherapy, or volumetric modulated radiotherapy, increased from 3.4% to 21.3% during those respective periods.

The study was published online July 6 in JAMA Network Open.

The findings suggest that innovations in systemic therapy and radiotherapy during the past decade were associated with improvements in clinical outcomes, the researchers conclude.

"This is good news for people affected by melanoma brain metastasis, a group with historically a very poor prognosis," lead author Timothy Hanna, MD, PhD, of the Cancer Research Institute at Queen's University, Kingston, Ontario, said in an interview.

Despite the advances, more than half of the patients with melanoma brain metastasis continued to receive WBRT in routine practice in the latter period of the analysis. This could be related to substantial disease burden at the time the brain metastasis was first detected or to geographic accessibility to focal brain therapies, the authors speculate.

In addition, during the period 2013 – 2016, many patients did not receive targeted therapeutic agents or immunotherapies.

Although the findings suggest that recent treatment advances have important benefits for people with melanoma brain metastasis, they also highlight "opportunities to further improve outcomes by optimizing the use of these novel treatments," Hanna told Medscape Medical News.

The study was supported by a grant from the Canadian Institutes of Health Research and by funding from the Institute for Clinical Evaluative Sciences and the Ontario Ministry of Health and Long-Term Care. Hanna has received grants from Roche and pilot funding from the Ontario Institute for Cancer Research outside the submitted work. Two coauthors report relationships with pharmaceutical companies, as listed in the original article.

JAMA Netw Open. Published online July 6, 2020. Full text

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