Artikel
Surgery of malignant melanoma brain metastasis in the light of checkpoint-and BRAF/MEK inhibitor therapy
Der Stellenwert der Chirurgie bei Patienten mit Melanom-Hirnmetastasen nach Einführung der Checkpoint- und BRAF/MEK Inhibitor Therapie
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Autoren
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Sophia Harlaß
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Silke Hennig
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Gabriele Schackert
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Friedegund Meier
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik für Dermatologie, Dresden, Deutschland
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Dietmar Krex
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: The implementation of checkpoint-inhibitor immunotherapy (CII) and inhibition of BRAF/MEK signaling pathway (BMI) in the treatment of malignant melanoma (MM) has dramatically improved survival-data of those patients. In consequence, the number of patients with MM brain metastasis (MMBM), which is a preferred route of spreading in those patients, has raised. Targeted therapies per se have a limited effect on MMBM. Therefore, the question when and which metastasis should be treated by surgery has to be reevaluated for that particular patient cohort.
Methods: We performed a retrospective analysis of MM patients who were treated with CII and/or BMI in the Department of Dermatology in our Hospital and/or had at least one operation for MMBM in our Department. Demographic and treatment-related data including MRI- and survival- data were evaluated and stored in a database. For statistical analysis nonparametric tests were used, particularly survival was analyzed using Kaplan-Meier estimator and compared by log-rank analysis.
Results: 82 patients (58 men; 24 women, age 29 - 82) were identified who had different status of metastasis when treatment started or brain metastasis were diagnosed, respectively. Numbers of MMBM initially: solitary: n=35; singular: n=15; oligo (<4): n=3; multiple: n=29, which varied during the course of treatments. The combination of surgery with CI and/or BMI was associated with significantly longer progression-free survival (PFS) than without surgery (p<0.012). Postoperative Rtx was associated with longer PFS but had no effect on OS. Patients experiencing the intense combination of all treatment modalities had significantly longer PFS than all other groups (p<0.001). Median overall survival was longest in patients who had been treated by surgery, Rtx and BMI (22.1 months).
Conclusion: Our data support our approach of an intense interdisciplinary follow-up of MMBM patients and a tight combination of CII, BMI, surgery and Rtx. Data need to be confirmed by larger multi-institutional cohorts as due to individualized treatment schedules, numerous subgroups are generated with comparatively small numbers hampering thorough statistical evaluation in many aspects.
