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BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Survival and clinical outcomes of patients with melanoma brain metastasis in the era of checkpoint inhibitors and targeted therapies

Authors: Elham Vosoughi, Jee Min Lee, James R. Miller, Mehdi Nosrati, David R. Minor, Roy Abendroth, John W. Lee, Brian T. Andrews, Lewis Z. Leng, Max Wu, Stanley P. Leong, Mohammed Kashani-Sabet, Kevin B. Kim

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

Melanoma brain metastasis is associated with an extremely poor prognosis, with a median overall survival of 4–5 months. Since 2011, the overall survival of patients with stage IV melanoma has been significantly improved with the advent of new targeted therapies and checkpoint inhibitors. We analyze the survival outcomes of patients diagnosed with brain metastasis after the introduction of these novel drugs.

Methods

We performed a retrospective analysis of our melanoma center database and identified 79 patients with brain metastasis between 2011 and 2015.

Results

The median time from primary melanoma diagnosis to brain metastasis was 3.2 years. The median overall survival duration from the time of initial brain metastasis was 12.8 months. Following a diagnosis of brain metastasis, 39 (49.4%), 28 (35.4%), and 24 (30.4%) patients were treated with anti-CTLA-4 antibody, anti-PD-1 antibody, or BRAF inhibitors (with or without a MEK inhibitor), with a median overall survival of 19.2 months, 37.9 months and 12.7 months, respectively. Factors associated with significantly reduced overall survival included male sex, cerebellar metastasis, higher number of brain lesions, and treatment with whole-brain radiation therapy. Factors associated with significantly longer overall survival included treatment with craniotomy, stereotactic radiosurgery, or with anti-PD-1 antibody after initial diagnosis of brain metastasis.

Conclusions

These results show a significant improvement in the overall survival of patients with melanoma brain metastasis in the era of novel therapies. In addition, they suggest the activity of anti-PD-1 therapy specifically in the setting of brain metastasis.
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Metadata
Title
Survival and clinical outcomes of patients with melanoma brain metastasis in the era of checkpoint inhibitors and targeted therapies
Authors
Elham Vosoughi
Jee Min Lee
James R. Miller
Mehdi Nosrati
David R. Minor
Roy Abendroth
John W. Lee
Brian T. Andrews
Lewis Z. Leng
Max Wu
Stanley P. Leong
Mohammed Kashani-Sabet
Kevin B. Kim
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4374-x

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