TY - JOUR
T1 - Impact of Novel Treatments in Patients with Melanoma Brain Metastasis
T2 - Real-World Data
AU - Derks, Sophie H A E
AU - Jongen, Joost L M
AU - van der Meer, Edgar L
AU - Ho, Li Shen
AU - Slagter, Cleo
AU - Joosse, Arjen
AU - de Jonge, Maja J A
AU - Schouten, Joost W
AU - Oomen-de Hoop, Esther
AU - van den Bent, Martin J
AU - van der Veldt, Astrid A M
N1 - Funding Information:
This research was funded by the Daniël den Hoed Foundation and the Erasmus MC Foundation.
Publisher Copyright:
© 2023 by the authors.
PY - 2023/2/25
Y1 - 2023/2/25
N2 - BACKGROUND: Melanoma brain metastasis (MBM) is associated with poor outcome, but targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) have revolutionized treatment over the past decade. We assessed the impact of these treatments in a real-world setting.METHODS: A single-center cohort study was performed at a large, tertiary referral center for melanoma (Erasmus MC, Rotterdam, the Netherlands). Overall survival (OS) was assessed before and after 2015, after which TTs and ICIs were increasingly prescribed.RESULTS: There were 430 patients with MBM included; 152 pre-2015 and 278 post-2015. Median OS improved from 4.4 to 6.9 months (HR 0.67,
p < 0.001) after 2015. TTs and ICIs prior to MBM diagnosis were associated with poorer median OS as compared to no prior systemic treatment (TTs: 2.0 vs. 10.9 and ICIs: 4.2 vs. 7.9 months,
p < 0.001). ICIs directly after MBM diagnosis were associated with improved median OS as compared to no direct ICIs (21.5 vs. 4.2 months,
p < 0.001). Stereotactic radiotherapy (SRT; HR 0.49,
p = 0.013) and ICIs (HR 0.32,
p < 0.001) were independently associated with improved OS.
CONCLUSION: After 2015, OS significantly improved for patients with MBM, especially with SRT and ICIs. Demonstrating a large survival benefit, ICIs should be considered first after MBM diagnosis, if clinically feasible.
AB - BACKGROUND: Melanoma brain metastasis (MBM) is associated with poor outcome, but targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) have revolutionized treatment over the past decade. We assessed the impact of these treatments in a real-world setting.METHODS: A single-center cohort study was performed at a large, tertiary referral center for melanoma (Erasmus MC, Rotterdam, the Netherlands). Overall survival (OS) was assessed before and after 2015, after which TTs and ICIs were increasingly prescribed.RESULTS: There were 430 patients with MBM included; 152 pre-2015 and 278 post-2015. Median OS improved from 4.4 to 6.9 months (HR 0.67,
p < 0.001) after 2015. TTs and ICIs prior to MBM diagnosis were associated with poorer median OS as compared to no prior systemic treatment (TTs: 2.0 vs. 10.9 and ICIs: 4.2 vs. 7.9 months,
p < 0.001). ICIs directly after MBM diagnosis were associated with improved median OS as compared to no direct ICIs (21.5 vs. 4.2 months,
p < 0.001). Stereotactic radiotherapy (SRT; HR 0.49,
p = 0.013) and ICIs (HR 0.32,
p < 0.001) were independently associated with improved OS.
CONCLUSION: After 2015, OS significantly improved for patients with MBM, especially with SRT and ICIs. Demonstrating a large survival benefit, ICIs should be considered first after MBM diagnosis, if clinically feasible.
UR - http://www.scopus.com/inward/record.url?scp=85149822356&partnerID=8YFLogxK
U2 - 10.3390/cancers15051461
DO - 10.3390/cancers15051461
M3 - Article
C2 - 36900253
AN - SCOPUS:85149822356
SN - 2072-6694
VL - 15
JO - Cancers
JF - Cancers
IS - 5
M1 - 1461
ER -
