Survival and treatment outcomes in patients with leptomeningeal disease from metastatic melanoma

被引:1
作者
Saberian, Chantal [1 ]
Milton, Denai R. [2 ]
Simon, Julie [1 ]
Amaria, Rodabe N. [1 ]
Diab, Adi [1 ]
Mcquade, Jennifer [1 ]
Patel, Sapna P. [1 ]
Tawbi, Hussein [1 ]
Yee, Cassian [1 ]
Wong, Michael K. [1 ]
Mccutcheon, Ian E. [1 ]
Davies, Michael A. [1 ]
Ferguson, Sherise D. [3 ]
Glitza Oliva, Isabella C. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Melanoma Med Oncol, 1515 Holcombe Blvd,Unit 430, Houston, TX 77030 USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Biostat, Houston, TX USA
[3] Univ Texas MD Anderson Canc Ctr, Dept Neurosurg, Houston, TX USA
关键词
intrathecal therapy; leptomeningeal disease; metastatic melanoma; systemic therapy; TARGETED THERAPY; SOLID TUMORS; OPEN-LABEL; CARCINOMATOSIS; VEMURAFENIB; INTERLEUKIN-2; IMMUNOTHERAPY; MULTICENTER; IPILIMUMAB; NIVOLUMAB;
D O I
10.1093/nop/npae026
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Melanoma leptomeningeal disease (LMD) has a poor prognosis. However, the management of patients with advanced melanoma has evolved with time, including those with LMD. We reviewed a large cohort of melanoma LMD patients to assess factors associated with survival.Methods Retrospective clinical data was collected on patients diagnosed with LMD at MD Anderson Cancer Center from 2015 to 2020. Overall survival (OS) was determined from LMD diagnosis to date of death or last follow-up. The Kaplan-Meier method and log-rank test were used to estimate OS and to assess univariate group differences, respectively. Multivariable associations of survival with variables of interest were determined using Cox proportional hazards regression models.Results A total of 172 patients were identified. The median age at LMD diagnosis was 53 (range 20-79) years, and all patients had radiographic evidence of LMD on magnetic resonance imaging of either brain or spine. In total 143 patients previously received systemic therapy (83%), with a median of 2 prior treatments (range 0-5). 81 patients (47%) had concurrent uncontrolled systemic disease and 80 patients (53%) had elevated serum LDH at the time of diagnosis. With a median follow-up of 4.0 months (range 0.1-65.3 months), median OS for all patients from LMD diagnosis was 4.9 months. Patients (n = 45) who received intrathecal therapy or systemic immunotherapy for LMD had a median OS of 8.0 months and 10.2 months, respectively. On multivariable analysis, decreased performance status, positive CSF cytology, elevated LDH, and whole brain radiation were associated with worse OS.Conclusions Despite many advances in therapeutic options, the outcomes of melanoma patients with LMD remains poor. However, a subset of patients appears to derive benefit from LMD-directed treatment.
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页码:452 / 463
页数:12
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