Prognosis of leptomeningeal metastases from melanoma: A case series of 28 patients.

Abstract

e13550 Background: Leptomeningeal metastasis (LM) are reported in 5-25% of patients with melanoma. However, only very few large contemporary cohorts of melanoma patients with LM have been published. Methods: We report on a case series of 28 consecutive patients with LM from melanoma (BRAF mutated in 14 cases, of 19 tested) diagnosed between April 2007 and April 2016, and treated for LM using a combination of systemic treatment, intra-cerebrospinal fluid (CSF) therapy and radiotherapy according to prior treatments and the presentation of LM. Results: The median age at LM diagnosis was 49.5 years (range 27-73). Median ECOG-performance status was 2 (0-4). Concomitant brain metastases were present in all but 4 patients at LM diagnosis. LM was the first site of metastatic disease for only 2 patients. Median time from melanoma diagnosis to LM diagnosis was 0.33 years in patients with metastatic disease at melanoma diagnosis (4 patients) and 4.5 years in patients without metastatic disease at melanoma diagnosis (24 patients). First line treatment for LM was a combination of intra-CSF (liposomal cytarabine) and systemic treatments in 25 cases, and systemic treatment alone in 3 cases. Systemic treatments include chemotherapy (n = 18), targeted therapy (BRAF inhibitor n = 9; MEK inhibitor, n = 3) and immunotherapy (n = 4). No radiotherapy was performed. Ten patients received more than one line of treatment for LM. Median progression-free survival with first line treatment was 1.75 months. Responses or stabilization (for at least 2 months) were observed in only 7 patients. Median overall survival (OS) for the whole cohort was 3.08 months. Conclusions: The prognosis of patients with LM from melanoma remains poor. The role of new agents such as targeted therapies and immunotherapy for the treatment of LM is still not well defined. Adequate use of intrathecal chemotherapy, targeted therapy and immunotherapy could improve the survival of these patients.