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Soo Park, MD
Soo Park, MD
Posted: Friday, October 11, 2024
Annie N.M. Wong, PhD, MBChB, FRACP, of Wellington Blood & Cancer Centre, New Zealand, and colleagues conducted a real-world study on use of anti–PD-1 monotherapy for melanoma brain metastases in New Zealand. Their findings, published in JCO Oncology Practice, indicate that although immune checkpoint inhibitors offered some survival benefit, 76% of those patients alive remained symptomatic neurologically. The study authors concluded that more effective treatments are necessary, particularly for patients with neurologic symptoms, a poor performance status, in need of corticosteroids.
The investigators evaluated the medical records of 144 patients with melanoma brain metastases across seven cancer centers in New Zealand from 2016 to 2020. A large majority (93%) of patients were treated with anti–PD-1 monotherapy, given the country’s restrictions on publicly funded treatments, the authors noted. Nearly 25% of the patients had a poor baseline performance status, 56% were symptomatic, and 33% required corticosteroids at the onset of treatment. Patients also received local therapies, including surgery (42%), stereotactic radiotherapy (33%), and whole-brain radiation (29%).
The median overall survival was 15 months, with one-third of patients alive at 2 years. Adverse events occurred in 28% of patients, with 15% experiencing severe (grade 3 or 4) toxicities. Of note, a large majority of patients who survived beyond 2 years continued to have neurologic symptoms.
“In our cohort, higher intracranial tumor burden was associated with poorer outcomes,” the investigators reported. “There was a statistically significant difference in the impact the number of brain metastases has on overall survival (P = .01). It is worth noting that patients who only had one brain metastasis had the greatest median overall survival at 17 months, whereby these brain metastases are often operable or can be targeted with SABR, reducing [the] intracranial disease burden.”
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
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