medwireNews: Melanoma patients with brain metastases can expect to live longer following the incorporation of checkpoint inhibitors and BRAF-targeted therapies into standard care than their counterparts treated prior to the approval of these agents, suggests an analysis of the US National Cancer Database.
Among 2753 patients who presented with stage IV melanoma with brain involvement in 2010–2015, the 4-year overall survival (OS) rate rose from 7.4% for those treated before 2011, which is when checkpoint inhibitors and BRAF inhibitors were approved initially, to 14.1% for individuals treated after this timepoint, a significant difference.
The corresponding median OS durations were 5.1 and 6.2 months.
Focusing just on patients diagnosed in the postapproval era, 28.1% of those who received first-line treatment with checkpoint inhibitors were alive at 4 years, which was significantly higher than the 11.1% rate for patients who did not, and median OS was 12.4 and 5.2 months, respectively.
These results held true in a multivariable analysis adjusting for confounders such as age, year of diagnosis, and receipt of brain-directed radiotherapy; checkpoint inhibitor therapy was associated with a significant 88% reduced risk for death in patients with melanoma and brain metastases.
The effects of checkpoint inhibitor therapy were “even more pronounced” among patients with brain-only metastases, say J Bryan Iorgulescu (Brigham and Women's Hospital, Boston, Massachusetts, USA) and co-authors. Specifically, the 4-year OS rates in these patients were 51.5% versus 16.9%, and median OS times were 56.4 versus 7.7 months, for participants who did versus did not receive checkpoint inhibitors.
By contrast, the corresponding 4-year rates were 17.9% and 7.0% for patients who additionally had extracranial metastases, while the median OS was 9.6 and 3.9 months, respectively.
Writing in Cancer Immunology Research, Iorgulescu et al summarize that “we demonstrated the dramatically improved OS following the incorporation of [checkpoint inhibitor therapy] into the standard of care in a national-scale analysis of a ‘real-world’ population of melanoma patients presenting with [brain metastases].”
They add that their results “help bridge the gaps in early clinical trials of [checkpoint inhibitor therapy] that largely excluded stage 4 melanoma patients with [brain metastases], with checkpoint immunotherapy demonstrating a more than doubling of the median and 4-year OS of [these patients].”
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