It's not news that melanoma sucks great big green, hairy, stinky wizard balls! It is also not news that should it progress to leptomeningeal disease it sucks even more. Here are prior reports on the topic:
August 2015: LMD - a case study, intrathecal admin of TIL's
October 2015: Intrathecal IL2 for LMD
February 2018: Retrospective review of IT IL2 in melanoma patients with LMD
Though I ranted for years - and it is only partially rectified today - patients with ANY CNS involvement of their melanoma were long denied access to clinical trials. Gradually, however, we ratties PROVED that both immunotherapy and targeted therapy work in the brain AND the body. That same access is routinely denied to patients with leptomeningeal disease (LMD) - still. THIS IS WRONG. PERIOD! FULL STOP.
Now, there's this:
Predictors of survival in metastatic melanoma patients with leptomeningeal disease (LMD). Ferguson, Bindal, Bassett, et al.J Neurooncol. 2019 Mar 7.
Although the survival of most melanoma patients diagnosed with leptomeningeal disease (LMD) is short, some patients can have better outcomes and prolonged survival. A large retrospective cohort of patients was analyzed to identify features associated with survival with LMD from melanoma. Clinical characteristics, treatments and survival were collected for melanoma patients diagnosed with LMD from 1999 to 2015. The Kaplan-Meier method was used to estimate overall survival (OS) and Cox proportional hazards regression was used to test statistical significance of associations with survival. Multivariate analysis was performed using Cox proportional regression modeling.
178 melanoma patients with LMD were identified. Median age at LMD diagnosis was 51 years. Most (n = 153) patients received at least one treatment for LMD, including radiation (n = 98), chemotherapy (n = 89), targeted therapy (n = 60), immunotherapy (n = 12), or intrathecal (IT) therapy (n = 64). Median OS from LMD diagnosis was 3.5 months. One-, two-, and five-year OS rates were 22%, 14%, and 9%, respectively. Factors significantly associated with OS on multivariate analysis included Eastern Cooperative Oncology Group [ECOG] performance status greater than 0; neurological symptoms; absent systemic disease; and LMD treatment, targeted therapy, or IT therapy.
Despite their overall poor prognosis a subset of melanoma patients with LMD achieve longer survival. The factors associated with outcomes may be used to guide patient management and to inform the design of future clinical trials for this population.
178 melanoma patients with LMD were identified. Median age at LMD diagnosis was 51 years. Most (n = 153) patients received at least one treatment for LMD, including radiation (n = 98), chemotherapy (n = 89), targeted therapy (n = 60), immunotherapy (n = 12), or intrathecal (IT) therapy (n = 64). Median OS from LMD diagnosis was 3.5 months. One-, two-, and five-year OS rates were 22%, 14%, and 9%, respectively. Factors significantly associated with OS on multivariate analysis included Eastern Cooperative Oncology Group [ECOG] performance status greater than 0; neurological symptoms; absent systemic disease; and LMD treatment, targeted therapy, or IT therapy.
Despite their overall poor prognosis a subset of melanoma patients with LMD achieve longer survival. The factors associated with outcomes may be used to guide patient management and to inform the design of future clinical trials for this population.
Sadly, still with incredibly poor OS numbers. But, at least folks are looking. This doesn't prove much other than...treatment helps!!!! So - let's provide treatment, shall we?????
This post in honor of sweet Adriana and her dear Rob. You are both in my heart - now and always. ~ les
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