Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy

Brain metastases commonly develop in melanoma and are associated with poor overall survival of about five to nine months. Fortunately, new therapies, including immune checkpoint inhibitors and BRAF/MEK inhibitors, have been developed. The aim of this study was to identify outcomes of different treat...

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Bibliographic Details
Published in:Cancers 2021-03, Vol.13 (7), p.1489
Main Authors: Rieth, John M, Swami, Umang, Mott, Sarah L, Zanaty, Mario, Henry, Michael D, Bossler, Aaron D, Greenlee, Jeremy D, Zakharia, Yousef, Vanneste, Marion, Jennings, Brooke, Milhem, Mohammed M
Format: Article
Language:English
Subjects:
Brain cancer
Chemotherapy
Clinical trials
CTLA-4 protein
Cytotoxicity
Dermatology
Immune checkpoint inhibitors
Immunotherapy
Life span
Medical prognosis
MEK inhibitors
Melanoma
Metastases
Metastasis
Morbidity
Patients
Radiation therapy
Surveillance
Survival
Tumors
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Summary:Brain metastases commonly develop in melanoma and are associated with poor overall survival of about five to nine months. Fortunately, new therapies, including immune checkpoint inhibitors and BRAF/MEK inhibitors, have been developed. The aim of this study was to identify outcomes of different treatment strategies in patients with melanoma brain metastases in the era of checkpoint inhibitors. Patients with brain metastases secondary to melanoma were identified at a single institution. Univariate and multivariable analyses were performed to identify baseline and treatment factors, which correlated with progression-free and overall survival. A total of 209 patients with melanoma brain metastases were identified. The median overall survival of the cohort was 5.3 months. On multivariable analysis, the presence of non-cranial metastatic disease, poor performance status (ECOG 2-4), whole-brain radiation therapy, and older age at diagnosis of brain metastasis were associated with poorer overall survival. Craniotomy (HR 0.66, 95% CI 0.45-0.97) and treatment with a CTLA-4 checkpoint inhibitor (HR 0.55, 95% CI 0.32-0.94) were the only interventions associated with improved overall survival. Further studies with novel agents are needed to extend lifespan in patients with brain metastases in melanoma.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers13071489