MET-5 OUTCOME OF MULTIDISCIPLINARY TREATMENT FOR BRAIN METASTASES IN PATIENTS WITH MELANOMA IN THE ERA OF MODERN SYSTEMIC THERAPY

Abstract

Abstract Objective Recently modern systemic therapy and stereotactic irradiation have been developed. We reviewed the therapeutic outcome of brain metastases (BM) in patients with melanoma. Methods Data of patients with melanoma BM were retrospectively analyzed. Patients underwent multidisciplinary treatment, whole brain radiotherapy, stereotactic irradiation, immune check point inhibitor (ICI) and/or BRAF inhibitor, therapeutic indication was discussed at cancer board. If they had 3cm over diameter, surgical resection for BM was performed, when systemic life expectancy longer than three months after control of their BM and controlled extra-CNS metastases. Radiotherapy of BM was selected with number, size and location. Overall survival was analysis with Kaplan-Meier survival curves. Results Eighty-four patients were treated melanoma BM between November 2004 and December 2021 at our institution. Median age was 61 years, and 54% male. Sixty-seven patients were treated BM, but 17 were selected best supportive care from progressive systemic disease. After radiotherapy, 18 patients were administrated ICI, and BRAF inhibitor 10, both ICI and BRAF inhibitor 5, cytotoxic chemotherapy 13. Median overall survival (mOS) of treatment group was 132 days (95%CI: 90-230) from the diagnosis of brain metastases, and 35 days for BSC. MOS in patients both local (radiotherapy and/or surgery for BM) and systemic therapy was longer than that of local alone (209, 64 days, p<0.0001). MOS of surgery group (n=10) was superior longer than the others (420, 92 days, p<0.0001). For treatment period, patients diagnosed BM after 2014 longer than that before 2013 (175, 117 days, p<0.0001), when ICI was started to use for melanoma in Japan. Conclusion Stereotactic irradiation and/or surgery supported with modern systemic therapy may be effective strategy in patients with melanoma BM. Further clinical investigations with larger cohort are needed to clarify appropriate assessments for patients with melanoma BM.