Background: Brain metastases are observed in more than 40% of all patients with stage 4 melanoma. In recent years, more extensive use of stereotactic radiation (STRT) and the advent of immune checkpoint inhibitors have positively impacted outcomes in patients with metastatic melanoma.brain metastases. Here, we examined real world clinical outcomes of patients presenting with melanoma brain metastases (MBMs). Methods: This retrospective review evaluated MBMs patients treated at The Ottawa Hospital from April 2000 to July 2017. Clinical, radiologic, pathologic and treatment information were gathered from the electronic medical records. The primary outcome was overall survival. The proportional Cox regression model was employed for survival data, while the Fisher's exact and Mann-Whitney U tests analyzed the relationship between categorical and continuous data, respectively. Results: This retrospective study included 276 patients. Brain metastases were detected symptomatically in 191 patients (69.2%); the rates of detection by routine screening were 4.6% in the pre-2012 era and 11.7% in the contemporary era (p = 0.029). Median survival was three months. Predictors of overall survival were age, higher lactate dehydrogenase (LDH) values, multiple brain lesions, more extensive extracranial disease, neurological symptoms, infratentorial lesions and treatment type. Multivariable analysis demonstrated that stereotactic radiotherapy (STRT) was associated with a hazard ratio of 0.401 (p < 0.001) for survival; likewise, immune checkpoint inhibitor therapy was associated with a hazard ratio of 0.375 (p < 0.001). Conclusion: The findings from this study as "real world" data are consistent with results of pivotal clinical trials in MBMs patients and support contemporary locoregional and immunotherapy practices.
Background: Brain metastases are observed in more than 40% of all patients with stage 4 melanoma. In recent years, more extensive use of stereotactic radiation (STRT) and the advent of immune checkpoint inhibitors have positively impacted outcomes in patients with metastatic melanoma.brain metastases. Here, we examined real world clinical outcomes of patients presenting with melanoma brain metastases (MBMs). Methods: This retrospective review evaluated MBMs patients treated at The Ottawa Hospital from April 2000 to July 2017. Clinical, radiologic, pathologic and treatment information were gathered from the electronic medical records. The primary outcome was overall survival. The proportional Cox regression model was employed for survival data, while the Fisher's exact and Mann-Whitney U tests analyzed the relationship between categorical and continuous data, respectively. Results: This retrospective study included 276 patients. Brain metastases were detected symptomatically in 191 patients (69.2%); the rates of detection by routine screening were 4.6% in the pre-2012 era and 11.7% in the contemporary era (p = 0.029). Median survival was three months. Predictors of overall survival were age, higher lactate dehydrogenase (LDH) values, multiple brain lesions, more extensive extracranial disease, neurological symptoms, infratentorial lesions and treatment type. Multivariable analysis demonstrated that stereotactic radiotherapy (STRT) was associated with a hazard ratio of 0.401 (p < 0.001) for survival; likewise, immune checkpoint inhibitor therapy was associated with a hazard ratio of 0.375 (p < 0.001). Conclusion: The findings from this study as "real world" data are consistent with results of pivotal clinical trials in MBMs patients and support contemporary locoregional and immunotherapy practices.
Authors: Harriet M Kluger; Veronica Chiang; Amit Mahajan; Christopher R Zito; Mario Sznol; Thuy Tran; Sarah A Weiss; Justine V Cohen; James Yu; Upendra Hegde; Elizabeth Perrotti; Gail Anderson; Amanda Ralabate; Yuval Kluger; Wei Wei; Sarah B Goldberg; Lucia B Jilaveanu Journal: J Clin Oncol Date: 2018-11-08 Impact factor: 44.544
Authors: Paul W Sperduto; Norbert Kased; David Roberge; Zhiyuan Xu; Ryan Shanley; Xianghua Luo; Penny K Sneed; Samuel T Chao; Robert J Weil; John Suh; Amit Bhatt; Ashley W Jensen; Paul D Brown; Helen A Shih; John Kirkpatrick; Laurie E Gaspar; John B Fiveash; Veronica Chiang; Jonathan P S Knisely; Christina Maria Sperduto; Nancy Lin; Minesh Mehta Journal: J Clin Oncol Date: 2011-12-27 Impact factor: 44.544
Authors: Michael A Davies; Philippe Saiag; Caroline Robert; Jean-Jacques Grob; Keith T Flaherty; Ana Arance; Vanna Chiarion-Sileni; Luc Thomas; Thierry Lesimple; Laurent Mortier; Stergios J Moschos; David Hogg; Iván Márquez-Rodas; Michele Del Vecchio; Céleste Lebbé; Nicolas Meyer; Ying Zhang; Yingjie Huang; Bijoyesh Mookerjee; Georgina V Long Journal: Lancet Oncol Date: 2017-06-04 Impact factor: 41.316
Authors: Kim Margolin; Marc S Ernstoff; Omid Hamid; Donald Lawrence; David McDermott; Igor Puzanov; Jedd D Wolchok; Joseph I Clark; Mario Sznol; Theodore F Logan; Jon Richards; Tracy Michener; Agnes Balogh; Kevin N Heller; F Stephen Hodi Journal: Lancet Oncol Date: 2012-03-27 Impact factor: 41.316
Authors: Wolfram E Samlowski; James Moon; Merle Witter; Michael B Atkins; John M Kirkwood; Megan Othus; Antoni Ribas; Vernon K Sondak; Lawrence E Flaherty Journal: Cancer Med Date: 2017-10-10 Impact factor: 4.452