The changing paradigm of management in melanoma brain metastases.

Abstract

e21027 Background: Brain metastases (BM) are a frequent complication in patients with metastatic melanoma (MM). We aimed to explore the outcome of these patient with modern therapeutic options. Methods: We retrospectively analysed 142 patients diagnosed with BM at a single site in Brisbane, QLD, Australia during 2009-2016. Basic clinico-pathological parameters, treatments used and mortality data were collected. Results: Patient characteristics included a median age of 57(17-82) years, presence of seizures (N = 18), dexamethasone use (N = 106) and BRAF mutant mm (N = 117). BM were categorised as solitary (N = 45), 2-6 (N = 65), more than 6 (N = 28) and leptomeningeal only (N = 4). BM were found on systemic treatment in 62 patients. Tyrosine kinase inhibitor (TKI) was used after the diagnosis of BM (N = 50). Management of BM included surgical resection (N = 39), Stereotactic radiosurgery (SRS) (N = 33) and Whole Brain Radiotherapy (N = 45). Immunotherapy with Ipilimumab (N = 35), Pembrolizumab (N = 36) and Nivolumab (N = 21) was used. With a median follow up of 8 months, 115 patients had died, 112 from MM. Death occurred due to progressive disease in the brain (N = 66), systemically (N = 13) or both (N = 33). The number of patients dying of mm were statistically higher on dexamethasone, increasing number of BM, BRAF mutants, absence of surgical resection or SRS and absence of immunotherapy use. Statistically Improved OS were found with solitary BM, treatment naive patients and surgical management of BM. In BRAF mutant patients who were TKI naïve at diagnosis of BM the mean OS was 14.7 versus 6.5 months in patients on TKI treatment (P < 0.05). In BRAF wild type patients mean OS was 11.7 months with PD1 use versus 8.3 months without PD1 use (Not Significant). Conclusions: Despite improvements in systemic treatment for mm the outcomes of those with BM remains poor. Solitary BM amenable to resection or ablation provides optimal treatment. The use of TKIs in BRAF mutant mm post BM diagnosis and the use of immunotherapy are effective treatment options.