Impact of radiotherapy administered simultaneously with systemic treatment in patients with melanoma brain metastases within MelBase, a French multicentric prospective cohort. (May 2019)

• Record Type: Journal Article
• Authors: Tétu, Pauline; Allayous, Clara; Oriano, Bastien; Dalle, Stéphane; Mortier, Laurent; Leccia, Marie-Thérèse; Guillot, Bernard; Dalac, Sophie; Dutriaux, Caroline; Lacour, Jean-Philippe; Saiag, Philippe; Brunet-Possenti, Florence; De Quatrebarbes, Julie; Stoebner, Pierre-Emmanuel; Legoupil, Delphine; Beylot-Barry, Marie; Lesimple, Thierry; Aubin, François; Dreno, Brigitte; Mohamed, Sameh; Ballon, Alice; Porcher, Raphaël; Lebbe, Céleste
• Is Part Of: European journal of cancer. Volume 112(2019)
• Page Start: 38
• Page End: 46
• Publication Date: 2019-05
• Subjects: Advanced melanoma -- Brain metastases -- Propensity score -- Radiotherapy -- Immunotherapy -- Targeted therapy; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2019.02.009
• Languages: English
• ISSNs: 0959-8049

Abstract

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. Highlights: This is a prospective multicenter observational cohort of advanced melanoma. Propensity scores are used to limit confusion and selection bias. Combined radiotherapy (cRT) increased overall survival in patients with brain metastases. cRT and systemic therapy decreased the risk of death by 40%. cRT and new systemic therapies may be synergistic.