Neurosurgery Resident NY Presbyterian Hospital/Weill Cornell Medical Center New York, New York
Background: Melanoma brain metastasis (MBM) prognosis has historically been dismal. However, breakthroughs in targeted and immunotherapies have improved long-term survival in advanced melanoma. As such, MBM presentation, prognosis and multimodality CNS-directed treatment use were reassessed in this contemporary age of treatment.
Methods: This retrospective study evaluated patients treated at Memorial Sloan Kettering Cancer Center between 2010-2019 with a diagnosis of melanoma brain metastases (MBM). Kaplan-Meier methodology was used to describe overall survival (OS). Recursive partitioning analysis (RPA) and time-dependent multivariable Cox modeling were used to assess prognostic variables and associate CNS-directed treatments with OS.
Results: Four hundred and twenty-five patients with 2,488 MBM were included. Median OS from MBM diagnosis was 8.9 months (95%CI: 7.9-11.3). RPA demonstrated significantly longer survival in patients diagnosed with MBM between 2015-2019 versus 2010-2014 (13.0 months [95%CI: 10.47-17.06] versus 7.0 months [95%CI: 6.1-8.3]; p=0.0003) andpatients with <5 BM versus ≥5 BM (12.49 months [95%CI: 10.52-16.03] versus 5.48 months [95%CI: 4.2-6.8];p<0.0001). Prognostic multivariable modeling significantly associated shortened OS independently with leptomeningeal dissemination (p<0.0001), >5 BM at diagnosis (p<0.0001), MBM diagnosis year 2010-2014 (p=0.0007), immunotherapy treatment prior to BM diagnosis (p=0.02), and extracranial disease presence (p=0.03). CNS-directed treatment modalities associated with BM number, dominant BM size, presenting symptoms, diagnosis year, and extracranial disease presence. Multivariable analysis demonstrated improved survival for patients that underwent craniotomy (p=0.01).
Conclusions: MBM prognosis has improved in the period following targeted and immunotherapy introduction, and even within the last 5 years of this study. Improving survival reflects and may influence the willingness to use aggressive multimodality treatment for MBM.