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. 2020 Jun 1;15(1):135.
doi: 10.1186/s13014-020-01558-8.

Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy : Melanoma brain metastases prognostic score

Jana Schaule  1   2 , Stephanie G C Kroeze  3 , Oliver Blanck  4   5 , Susanne Stera  6 , Klaus H Kahl  7 , Falk Roeder  8 , Stephanie E Combs  9   10   11 , David Kaul  12 , An Claes  13 , Markus M Schymalla  14 , Sonja Adebahr  15   16   17 , Franziska Eckert  18 , Fabian Lohaus  17   19   20 , Nasrin Abbasi-Senger  21 , Guido Henke  22 , Marcella Szuecs  23 , Michael Geier  24 , Nora Sundahl  25 , Daniel Buergy  26 , Reinhard Dummer  27 , Matthias Guckenberger  3
Affiliations

Predicting survival in melanoma patients treated with concurrent targeted- or immunotherapy and stereotactic radiotherapy : Melanoma brain metastases prognostic score

Jana Schaule et al. Radiat Oncol. .

Erratum in

Abstract

Background: Melanoma patients frequently develop brain metastases. The most widely used score to predict survival is the molGPA based on a mixed treatment of stereotactic radiotherapy (SRT) and whole brain radiotherapy (WBRT). In addition, systemic therapy was not considered. We therefore aimed to evaluate the performance of the molGPA score in patients homogeneously treated with SRT and concurrent targeted therapy or immunotherapy (TT/IT).

Methods: This retrospective analysis is based on an international multicenter database (TOaSTT) of melanoma patients treated with TT/IT and concurrent (≤30 days) SRT for brain metastases between May 2011 and May 2018. Overall survival (OS) was studied using Kaplan-Meier survival curves and log-rank testing. Uni- and multivariate analysis was performed to analyze prognostic factors for OS.

Results: One hundred ten patients were analyzed. 61, 31 and 8% were treated with IT, TT and with a simultaneous combination, respectively. A median of two brain metastases were treated per patient. After a median follow-up of 8 months, median OS was 8.4 months (0-40 months). The molGPA score was not associated with OS. Instead, cumulative brain metastases volume, timing of metastases (syn- vs. metachronous) and systemic therapy with concurrent IT vs. TT influenced OS significantly. Based on these parameters, the VTS score (volume-timing-systemic therapy) was established that stratified patients into three groups with a median OS of 5.1, 18.9 and 34.5 months, respectively (p = 0.001 and 0.03).

Conclusion: The molGPA score was not useful for this cohort of melanoma patients undergoing local therapy for brain metastases taking into account systemic TT/IT. For these patients, we propose a prognostic VTS score, which needs to be validated prospectively.

Keywords: Brain metastases; Immunotherapy; Melanoma; Stereotactic; Targeted therapy; molGPA.

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Conflict of interest statement

NS: travel grants from Merck Sharpe & Dohme, Astellas, Bayer and Bristol-Myers-Squibb. DB reports personal fees from Siemens AG, personal fees from NB Capital Research GmbH, personal fees from NB Capital ApS, personal fees from b.e. Imaging GmbH outside the submitted work. MS: remuneration for lectures from Merck Serono and AstraZeneca.

All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves comparing (a) the molGPA score with (b) the VTS score including cumulative brain metastases volume, timing of metastases, cumulative brain metastases volume and concomitant systemic treatment
Fig. 2
Fig. 2
Receiver operating curves (ROC, red line = diagonal reference line) for (a) the molGPA score and (b) the VTS score for the binary endpoint of 6-months-OS with 60 patients reaching this endpoint. The AUC was improved with the VTS score
See this image and copyright information in PMC

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References

    1. Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg. 1978;135:807–810. doi: 10.1016/0002-9610(78)90171-X. - DOI - PubMed
    1. Sampson JH, Carter JH, Friedman AH, Seigler HF. Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma. J Neurosurg. 1998;88:11–20. doi: 10.3171/jns.1998.88.1.0011. - DOI - PubMed
    1. Gaudy-Marqueste C, Dussouil AS, Carron R, et al. Survival of melanoma patients treated with targeted therapy and immunotherapy after systematic upfront control of brain metastases by radiosurgery. Eur J Cancer. 2017;84:44–54. doi: 10.1016/j.ejca.2017.07.017. - DOI - PubMed
    1. Goyal S, Silk AW, Tian S, Mehnert J, Danish S, Ranjan S, et al. Clinical Management of Multiple Melanoma Brain Metastases: a systematic review. JAMA Oncol. 2015;1:668–676. doi: 10.1001/jamaoncol.2015.1206. - DOI - PMC - PubMed
    1. Long GV, Atkinson V, Lo S, et al. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomised phase 2 study. Lancet Oncol. 2018;19:672–681. doi: 10.1016/S1470-2045(18)30139-6. - DOI - PubMed

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