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MO_6_2597 - Outcomes for advanced melanoma with brain metastases treated with stereotactic radiosurgery (SRS) with and without anti-PD1/PDL1 therapy

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Outcomes for advanced melanoma with brain metastases treated with stereotactic radiosurgery (SRS) with and without anti-PD1/PDL1 therapy
N. Harandi, A. Goel, A. J. Huang, K. E. Huang, R. E. Abendroth, J. W. Lee, M. Kashani-Sabet, and K. Kim; California Pacific Medical Center, San Francisco, CA

Purpose/Objective(s): Given improvements in systemic therapy, metastatic melanoma to the brain represents a rapidly growing subgroup of advanced melanoma patients, with intracranial disease control being an increasingly important goal. These patients are often treated with stereotactic radiosurgery (SRS) and anti-PD1 therapy, which have independently demonstrated efficacy in improving survival. However, limited data exists regarding the management of brain metastatic melanoma using a combination of such therapies.

Materials/Methods: We performed a single institution retrospective analysis of outcomes of patients with brain metastases of melanoma primary treated with SRS and PDL1 therapy compared to SRS alone. Patients diagnosed with metastatic brain lesions of melanoma primary whose management included one or more courses of SRS between 2011 and 2015 were identified. Patient and treatment characteristics were reviewed, including the types of systemic therapy received. Survival was measured from time of diagnosis of brain metastases to death or last follow-up. Overall survival was compared between patients who received or did not receive PDL1 therapy using Kaplan Meier curves with log-rank testing. Multivariate Cox regression analysis was performed to account for other potentially confounding factors. Rates of post-SRS radionecrosis were also assessed.

Results: Fifty-two patients had brain lesions treated with SRS, of which 31 received SRS alone and 21 also received anti-PD1 therapy. There were no significant differences between the two treatment groups with respect to age, number of metastases, or rates of prior CTLA4 or BRAF therapy. Median survival for the combined cohort was 16 months. Median survival was significantly longer in patients receiving SRS+PD1 therapy vs SRS alone, 52 vs 12 months, respectively (p=0.011). Overall survival at 1 year was 86% and 67%, respectively, and at 2 years was 61% and 21%, respectively. A multivariate Cox regression that included age, sex, receipt of craniotomy, prior systemic therapy, number of brain metastases, and extracranial disease control revealed that PDL1 therapy remained an independent predictor of survival (p=0.026). Receipt of craniotomy and extracranial disease control were also statistically favorable prognostic factors (p=0.038 and p=0.037, respectively). Radiographic radionecrosis was observed in three (5.7%) patients, of which two were in patients receiving both SRS+PDL1 therapy.

Conclusion: The survival of patients with melanoma brain metastases was significantly improved with the addition of the PD-1 antibody to SRS, with benefit remaining on multivariate analysis. The combination of these therapies appears to be safe and offers durable benefit to this growing subset of patients with advanced melanoma.

Author Disclosure: N. Harandi: None. A. Goel: None. R. Abendroth: None. J.W. Lee: None. M. Kashani-Sabet: None. K. Kim: None.

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