Thursday, June 7, 2018

ASCO 2018 - Survival of folks having melanoma brain mets with immunotherapy

I bet we can all guess the result here....but, this report may be helpful to those who want to "SEE the numbers" adjusted for our "new" treatment options via immunotherapy.  After all, when I was diagnosed with a brain met in 2010 (before BRAFi and any immunotherapy were FDA approved), I was given 6 months to live and the A##HAT radiologist who performed the SRS to my lesion advised my husband that I'd be back in a few months for whole brain radiation!  Here you go:

Risk-adjusted survival for melanoma brain metastases in the era of checkpoint blockade immunotherapies: Results from a national cohort. Lorgulescu, Harary, Zogg, … Hodi, et al. ASCO 2018.

Background:The recent successes of checkpoint blockade immunotherapy (CBI) and BRAFV600-targeted therapy trials have generated exciting promise for revolutionizing the management of patients with advanced melanoma. However, because early clinical trials of CBIs and BRAFV600-targeted therapy either excluded or included disproportionately fewer cases of melanoma brain metastases (MBM), the survival benefit of these novel therapies for MBM remains unknown.
Methods:The characteristics, management, and overall survival (OS) outcomes of patients who presented with cutaneous MBMs during 2010-2015 were evaluated using the National Cancer Database, which comprises approximately 70% of all newly diagnosed cancers in the U.S. OS was analyzed with risk-adjusted Cox proportional hazards and compared by Kaplan-Meier techniques.
Results:2,753 (36%) of patients presenting with stage 4 melanoma had MBMs. MBM patients who presented after the 2011 FDA approvals for CBI and BRAFV600-targeted therapy demonstrated a 91% relative increase in 4-yr OS to 14.1% from 7.4% pre-approval. In the post-approval era, the proportion of MBM patients that received CBI rose from 10.5% in 2011 to 34.0% in 2015. Initial CBI in MBM patients displayed a 2.4x improved median and 4-yr OS of 12.4 mos (vs 5.2 months)  and 28.1% (vs 11%). These benefits were particularly pronounced in MBM patients without extracranial metastases, in which CBI demonstrated improved median and 4-yr OS of 56.4 mos (vs 7.7 months) and 51.5% (vs 16.9%) that persisted in MBMs that underwent resection or SRS.
Conclusions:Using a large national cohort comprised of a “real-life” treatment population of MBMs, we demonstrate the dramatic improvements in OS associated with novel checkpoint blockade immunotherapies.

So, yep!  We guessed it.  YES!!!  Immunotherapy works in the brain and once folks with brain mets were finally ALLOWED to partake of immunotherapy, they did much better.  And, yes, I have ranted long and hard about all of that!!!  
There was this in 2013:  ASCO 2013 - Brain mets in Melanoma...the latest from ASCO  
2014:  Should Melanoma Brain Met patients be allowed in clinical trials???  
2015:  A really good review of treatment data for Melanoma Brain Mets!!!  
2016:  ASCO 2016 - Immunotherapy in melanoma brain mets
2017:  ASCO 2017 - Melanoma brain mets

But, back to the study ~ 
Here, using the National Cancer Database (to which about 70% of newly diagnosed cancers across the US are reported [should be ALL in my opinion]), researchers looked at folks with melanoma brain mets.  They found that between 2010 and 2015, 36% (2,753) of all folks who were diagnosed with Stage IV cutaneous melanoma had brain mets.  [Interesting.  I hadn't really seen that number broken down.]  They note that since the FDA approval of the BRAF inhibitors and immunotherapy, 4 year overall survival in melanoma brain met patients has increased 91% from 7.4% to 14.1%.  (From about 5 months to over a year.)  They also note, that folks who had no other mets in their body did better, surviving an average of 56 months vs 7 months with immunotherapy.  [Not really news as we know that folks on all therapies do best with the lowest possible tumor burden.]  BUT!!!!!!!!!!!!!  When melanoma brain met patients underwent surgical removal or radiation to the brain met the percentage of survival pretty much held.

That last brings me to my most recent rant.  Here are 9 ZILLION posts/articles noting:  CONCURRENT radiation and immunotherapy for brain mets is BEST!!!! (yes, AGAIN!!!)  

Melanoma still sucks great big green, stinky, hairy, wizard balls!  And sadly, brain mets even more so.  BUT!!!  There is hope.  Especially when immunotherapy (and BRAFi as well, for that matter) is COMBINED with radiation!!!  If you or your dear once has a melanoma brain met and someone tells you that the combination of SRS or gamma knife radiation WITH immunotherapy is NOT a good treatment plan???!!!  RUN AWAY!!!  Seek help elsewhere.  Your life may depend on it.

For what it's worth. - c

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