Pauline Tétu1, Clara Allayous2, Bastien Oriano3, Stéphane Dalle4, Laurent Mortier5, Marie-Thérèse Leccia6, Bernard Guillot7, Sophie Dalac8, Caroline Dutriaux9, Jean-Philippe Lacour10, Philippe Saiag11, Florence Brunet-Possenti12, Julie De Quatrebarbes13, Pierre-Emmanuel Stoebner14, Delphine Legoupil15, Marie Beylot-Barry16, Thierry Lesimple17, François Aubin18, Brigitte Dreno19, Sameh Mohamed2, Alice Ballon20, Raphaël Porcher3, Céleste Lebbe2. 1. APHP Dermatology, Department of Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France. Electronic address: pauline.tetu@hotmail.fr. 2. APHP Dermatology, Department of Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France. 3. Clinical Epidemiology Center, AP-HP, Hôtel-Dieu, Paris, France. 4. Hospices Civils De Lyon, Pierre-Bénite, France. 5. Dermatology Department, CHRU Lille, Lille, France. 6. Dermatology Department, CHU Albert Michalon, Grenoble, University of Grenoble, Grenoble, France. 7. Dermatology Department, Universitary Hospital of Montpellier, CHU Montpellier, Montpellier, France. 8. Dermatology, University Hospital of Dijon, Dijon, France. 9. Dermatology and Pediatric Dermatology Department, Bordeaux Hospital, Bordeaux, France, Bordeaux, France. 10. Dermatology Department, Nice Hospital, Nice, France, Nice, France. 11. AP-HP, Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France. 12. AP-HP, Dermatology, Bichat Hospital, Paris, France. 13. Dermatology, CHR Annecy Genevois, Annecy, France. 14. Dermatology, CHU de Nimes, Nimes, France. 15. Dermatology, CHU Brest, Brest, France. 16. Dermatology, Hôpital Saint-André, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France. 17. Centre d'Oncodermatologie CLCC/CHU de Rennes, Rennes, France. 18. Dermatology, CHU de Besançon, Besançon, France. 19. Dermatology, CHU de Nantes, Nantes, France. 20. Data Management, AP-HP, Hôpital Saint-Louis, Paris, France.
Abstract
BACKGROUND: Melanoma brain metastases (MBMs) are historically associated with poor prognosis. Radiation therapy is conventionally associated with a high local control rate. Development of targeted therapy and immunotherapy has improved overall survival (OS) and intracranial response rate, but about 50% of patients failed to respond to these novel therapies. The objective of this study was to assess the impact of combined radiotherapy (cRT) on overall survival in a large multicenter real-life prospective cohort of patients with MBM treated with immunotherapy or targeted therapy. PATIENTS AND METHODS: Clinical data from 262 patients with MBM were collected via MelBase, a French multicentric biobank prospectively enrolling unresectable stage III or IV melanoma. Two groups were defined: patients receiving cRT (cRT group) or not receiving cRT (no-cRT group). Primary end-point was OS. Propensity score weighting was used to correct for indication bias. RESULTS: Among the 262 patients, 93 (35%) received cRT (cRT group). The patients were treated with immunotherapy in 69% and 60% and with targeted therapy in 31% and 40% of the cRT and no-cRT groups, respectively. With a median follow-up of 6.9 months, median OS was 16.8 months and 6.9 months in the cRT and no-cRT groups, respectively. After propensity score weighting, cRT was associated with longer OS (hazard ratio = 0.6, 95% confidence interval: 0.4-0.8; p=0.007). Median OS after ponderation was 15.3 months and 6.2 months in the cRT and no-cRT groups, respectively. CONCLUSION: This study shows that cRT may be associated with a significant decrease of 40% in the risk of death in patients with MBM treated with systemic therapy.
BACKGROUND:Melanoma brain metastases (MBMs) are historically associated with poor prognosis. Radiation therapy is conventionally associated with a high local control rate. Development of targeted therapy and immunotherapy has improved overall survival (OS) and intracranial response rate, but about 50% of patients failed to respond to these novel therapies. The objective of this study was to assess the impact of combined radiotherapy (cRT) on overall survival in a large multicenter real-life prospective cohort of patients with MBM treated with immunotherapy or targeted therapy. PATIENTS AND METHODS: Clinical data from 262 patients with MBM were collected via MelBase, a French multicentric biobank prospectively enrolling unresectable stage III or IV melanoma. Two groups were defined: patients receiving cRT (cRT group) or not receiving cRT (no-cRT group). Primary end-point was OS. Propensity score weighting was used to correct for indication bias. RESULTS: Among the 262 patients, 93 (35%) received cRT (cRT group). The patients were treated with immunotherapy in 69% and 60% and with targeted therapy in 31% and 40% of the cRT and no-cRT groups, respectively. With a median follow-up of 6.9 months, median OS was 16.8 months and 6.9 months in the cRT and no-cRT groups, respectively. After propensity score weighting, cRT was associated with longer OS (hazard ratio = 0.6, 95% confidence interval: 0.4-0.8; p=0.007). Median OS after ponderation was 15.3 months and 6.2 months in the cRT and no-cRT groups, respectively. CONCLUSION: This study shows that cRT may be associated with a significant decrease of 40% in the risk of death in patients with MBM treated with systemic therapy.
Authors: Justin T Moyers; Esther G Chong; Jiahao Peng; Hsin Hsiang Clarence Tsai; Daniel Sufficool; David Shavlik; Gayathri Nagaraj Journal: Cancer Med Date: 2021-01-22 Impact factor: 4.452
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