gms | German Medical Science

Objective: In recent years, malignant melanoma has gone through a plethora of new treatment options. Still, melanoma patients with brain metastases (BM) have limited survival and moreover, are excluded from most clinical trials.

Method: A total of 975 patients with newly diagnosed cutaneous malignant melanoma were identified in a retrospective single-institutional analysis between 01.01.2007–31.12.2011. Recurrence-free survival times until BM (RFS-BM) and post-BM survival were correlated to therapy modalities applied pre- and post-BM. Univariate associations were analyzed using Kaplan-Meier survival analysis and the multivariate Cox proportional hazards regression. P-values were adjusted using the χ2-test.

Results: Mean age at primary diagnosis was 59,7 years (ranging from 20 to 91 years), 54% were male. 6,7% (n=65) of patients developed BM at a median follow-up time of 22 months. 56% of these were symptomatic with palsies (60%), dysphasia (50%), symptoms of elevated intracranial pressure or hydrocephalus (30%) or seizure (15%). After multivariate analyses, clinical variables significantly predictive of BM included the histological subtype and the AJCC stadium (p<0.001). The use of newer agents applied for the treatment of primary melanoma, such as Ipilipumab and Vemurafinib did not have a significant influence on the incidence of BM. Median post-BM survival was 17.4 months, significantly influenced by the kind of therapy applied for BM (neurosurgical resection followed by WBRT (= therapy 1) (in 20%), SRS only (= therapy 2) (in, 13%), WBRT only (= therapy 3) (in 26%) or best supportive care (= therapy 4) (in 30%). For therapies 1–4, 6-month, 12-month and 2-year survival rates post-BM were 100%, 100%, 34%, 43 and 100%, 85%, 0%, 0%, and 84%, 42%, 0% and 0%, respectively (p<0.001). Post-BM therapy included Ipilipumab in 13, and Vemurafinib in 8 patients, followed by therapy 1 or therapy 2. Comparing patients with or without newer therapies, patients benefitted from newer therapies with 12- and 24-month survival rates were 77% vs. 45% and 57% vs. 15%, respectively (p=0.2).

Conclusions: Patients with brain metastases from melanoma seem to benefit from newer therapeutic agents, if combined with neurosurgical resection followed by WBRT or SRS. Clinical trials should therefore include patients with brain metastases to reassess our data with higher patient numbers.