Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, 2100 Webster Street, Suite 326, San Francisco, CA, 94115, USA.
BMC Cancer. 2018 Apr 27;18(1):490. doi: 10.1186/s12885-018-4374-x.
Melanoma brain metastasis is associated with an extremely poor prognosis, with a median overall survival of 4-5 months. Since 2011, the overall survival of patients with stage IV melanoma has been significantly improved with the advent of new targeted therapies and checkpoint inhibitors. We analyze the survival outcomes of patients diagnosed with brain metastasis after the introduction of these novel drugs.
We performed a retrospective analysis of our melanoma center database and identified 79 patients with brain metastasis between 2011 and 2015.
The median time from primary melanoma diagnosis to brain metastasis was 3.2 years. The median overall survival duration from the time of initial brain metastasis was 12.8 months. Following a diagnosis of brain metastasis, 39 (49.4%), 28 (35.4%), and 24 (30.4%) patients were treated with anti-CTLA-4 antibody, anti-PD-1 antibody, or BRAF inhibitors (with or without a MEK inhibitor), with a median overall survival of 19.2 months, 37.9 months and 12.7 months, respectively. Factors associated with significantly reduced overall survival included male sex, cerebellar metastasis, higher number of brain lesions, and treatment with whole-brain radiation therapy. Factors associated with significantly longer overall survival included treatment with craniotomy, stereotactic radiosurgery, or with anti-PD-1 antibody after initial diagnosis of brain metastasis.
These results show a significant improvement in the overall survival of patients with melanoma brain metastasis in the era of novel therapies. In addition, they suggest the activity of anti-PD-1 therapy specifically in the setting of brain metastasis.
黑色素瘤脑转移与极差的预后相关，中位总生存期为 4-5 个月。自 2011 年以来，随着新型靶向治疗和检查点抑制剂的出现，IV 期黑色素瘤患者的总体生存率显著提高。我们分析了这些新型药物引入后诊断为脑转移的患者的生存结果。
我们对黑色素瘤中心数据库进行了回顾性分析，确定了 2011 年至 2015 年间 79 例脑转移患者。
从原发性黑色素瘤诊断到脑转移的中位时间为 3.2 年。从初次脑转移开始的中位总生存时间为 12.8 个月。在诊断为脑转移后，39 例（49.4%）、28 例（35.4%）和 24 例（30.4%）患者接受了抗 CTLA-4 抗体、抗 PD-1 抗体或 BRAF 抑制剂（联合或不联合 MEK 抑制剂）治疗，中位总生存时间分别为 19.2 个月、37.9 个月和 12.7 个月。与总生存时间显著缩短相关的因素包括男性、小脑转移、脑内病变数量较多，以及全脑放疗。与总生存时间显著延长相关的因素包括初始脑转移诊断后行开颅手术、立体定向放射外科手术或接受抗 PD-1 抗体治疗。
这些结果表明，在新型治疗时代，黑色素瘤脑转移患者的总体生存率显著提高。此外，它们还提示抗 PD-1 治疗在脑转移中的活性。
