Wednesday, March 1, 2017

SRS with any systemic therapy helps response in melanoma...but anti-PD-1 WITH SRS = best OS in brain mets

I have been yelling for the longest....Radiation WITH systemic treatment is an incredibly beneficial combo for melanoma ANYWHERE, but especially in the brain!!!  This link:  Radiation and Melanoma  will take you to about 9 million research reports!!!  Now there's a breakdown of how folks SURVIVE melanoma brain mets when radiation is combined with 3 different therapies...ipi, BRAF/MEK, and anti-PD-1....

Survival of patients with melanoma brain metastasis treated with stereotactic radiosurgery and active systemic drug therapies. Choong, Lo, Drummond, et al. Eur J Cancer. 2017 Feb 22.

With new systemic therapies demonstrating activity in melanoma brain metastasis, most of the previously reported stereotactic radiosurgery (SRS) data are superseded. In this study, we report the outcomes (overall survival [OS] and brain control [BC]) and identify factors that associate with such outcomes in the era of modern systemic therapy.

A total of 108 patients treated with SRS from 2010 to 2015 were included. Systemic treatment use within 6 weeks of SRS was noted. OS was defined as time from SRS to death or last follow-up...[statistical] analyses were performed on clinico-pathological prognostic features associated with OS and BC.

The median age was 64.3 years, and the median follow-up was 8.6 months. Seventy-nine (73.1%) patients received systemic treatment. The median OS were as follows: anti-CTLA4 - 7.5 months, anti-PD1 - 20.4 months and BRAF inhibitor (BRAFi) ± MEK inhibitor (MEKi) - 17.8 months. Median BC was as follows: anti-CTLA4 - 7.5 months, anti-PD1 - 12.7 months and BRAFi ± MEKi - 12.7 months. In multivariate analysis, age and type of systemic therapy were strongly associated with OS. Age, Eastern Cooperative Oncology Group performance status, Graded Prognostic Assessment (GPA) score, and presence of symptoms were associated with BC.  

Favourable outcomes are seen in patients treated with SRS and with the best survival seen in patients treated with anti-PD1. Known independent prognostic factors for survival such as age and performance status and GPA score remain relevant in this setting.

To reinterate:  Ipi with SRS = 7.5 month OS.  BRAF/MEK with SRS = 17.8 months OS.  Anti-PD-1 with SRS = 20.4 month OS.  I would assume that the ipi/nivo combo would provide an even longer OS when combined with SRS....though that treatment was not addressed in this study.  Wishing you well. - c

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