Advances in RT Lead to Improved Outcomes in Patients With Melanoma Brain Metastases

The evolution of radiotherapy techniques and therapies have improved clinical outcomes among patients with melanoma brain metastases since 2007, according to findings from a population-based study (JAMA Network Open. 2020 Jul 1. Epub ahead of print).

“Treatments for melanoma brain metastasis changed between 2007 and 2016 with the advent of new radiotherapy techniques, targeted therapeutic agents, and immunotherapy,” wrote Harry C. Brastianos, MD, PHD, Queen’s University, Kingston, Ontario, Canada, and co-investigators.

According to Dr Brastianos et al, there have been no large population-based studies to systemically investigate changes in clinical outcomes despite guidelines for systemic therapy evolving over time.

Therefore, the researchers sought to investigate the association between innovations in systemic therapy and radiotherapy techniques for treating melanoma brain metastases and changes to clinical outcomes among patients with this condition.

A total of 1096 patients with melanoma brain metastases who received treatment in Ontario between January 2007 and June 2016 were included in this retrospective study. These patients were split into cohorts based on when they received therapy; 326 patients treated from 2007 to 2009 were in Period 1; 310 patients who received treatment from 2010 to 2012 were in Period 2; and 460 patients treated between 2013 and 2016 were in Period 3.

The primary end points examined were overall survival, whole-brain radiotherapy-free survival, and time to subsequent brain treatment.

The 1-year overall survival rate was greater in Period 3 at 21.8% versus 12.3% in Period 1. The 2-year overall survival rates were 13.8% and 6.4%, respectively.

Use of whole-brain radiotherapy decreased between Period 1 and Period 3, although 61.5% of patients received whole brain-radiotherapy in Period 3. The use of partial-brain radiotherapy techniques and multiple brain-directed treatments increased from Period 1 to Period 3.

The researchers also noted an increase in the annual number of patients with melanoma brain metastases, and an increase in the overall incidence of melanoma in Ontario.

“These findings suggest that innovations in systemic therapy and radiotherapy are associated with improvements in clinical outcomes among patients with melanoma brain metastasis, even in population-wide routine practice,” Dr Brastianos et al stated, highlighting that overall survival improved over time, and the use of whole-brain radiotherapy decreased.

“The findings suggest important benefits for people with melanoma brain metastasis, with opportunities to further improve outcomes by optimizing the use of advanced radiotherapy techniques and novel systemic therapies,” they concluded.—Kaitlyn Manasterski