In a study reported in Journal of Clinical Oncology, Sperduto and colleagues analyzed trends in survival associated with newly diagnosed melanoma brain metastases and updated the Melanoma Graded Prognostic Assessment (GPA).
Study Details
The study involved retrospective data from multi-institutional databases on 1,796 patients with newly diagnosed melanoma brain metastases treated between January 2015 and December 2021 with modern multimodal therapies; survival was compared with cohorts treated between 1985–2007 (n = 481) and 2006–2015 (n = 823) and new/additional prognostic factors were identified to update the Melanoma GPA.
Key Findings
Median overall survival was 6.7 months (median follow-up = 40.1 months) in the 1985–2007 cohort, 9.8 months (median follow-up = 43.6 months) in the 2006–2015 cohort, and 16.6 months (median follow-up = 48.8 months) in the 2015–2021 cohort.
In multivariate analyses in the 2015–2021 cohort, significant prognostic factors for improved survival were higher Karnofsky Performance Status (hazard ratio [HR] = 0.52 for 70–80 and 0.33 for 90–100), fewer melanoma brain metastases (HR = 0.56), absence of extracranial metastases (HR = 0.62), lower lactate dehydrogenase (HR = 0.71), and prior immune checkpoint inhibitor treatment (HR = 0.72).
The above factors were incorporated into the updated Melanoma GPA. Median and 3-year overall survival were: 5.4 months and 12.4% among patients with GPA = 0–1; 13.2 months and 28.8% among those with GPA = 1.5–2; and 43.2 months and 51.6% among those with GPA = 2.5–4.0.
The investigators concluded: “Prognostic factors have changed and survival has improved for patients with [melanoma brain metastases] but varies widely by GPA. The updated Melanoma GPA calculator (BrainMetGPA), available free online, can be used to estimate survival, individualize treatment, stratify clinical trials, guide surveillance, and augment clinical trial eligibility. Multidisciplinary treatment is essential. Trials are needed to elucidate the optimal sequencing of various therapeutic modalities.”
Paul W. Sperduto, MD, of Duke University, is the corresponding author for the Journal of Clinical Oncology article.
Disclosures: This study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
