Upfront Surgical Resection of Melanoma Brain Metastases Provides a Bridge Toward Immunotherapy-Mediated Systemic Control

The Oncologist
Christopher Alvarez-BreckenridgePriscilla K Brastianos

Abstract

Immune checkpoint blockade has systemic efficacy in patients with metastatic melanoma, including those with brain metastases (MBMs). However, immunotherapy-induced intracranial tumoral inflammation can lead to neurologic compromise, requiring steroids, which abrogate the systemic efficacy of this approach. We investigated whether upfront neurosurgical resection of MBM is associated with a therapeutic advantage when performed prior to initiation of immunotherapy. An institutional review board-approved, retrospective study identified 142 patients with MBM treated with immune checkpoint blockade between 2010 and 2016 at Massachusetts General Hospital, of whom 79 received surgery. Patients were classified based on the temporal relationship between immunotherapy, surgery, and development of central nervous system metastases. Overall survival (OS) was calculated from the date of diagnosis of MBM until death from any cause. Multivariate model building included a prognostic Cox model of OS, the effect of immunotherapy and surgical sequencing on OS, and the effect of immunotherapy and radiation sequencing on OS. The 2-year overall survival for patients treated with cytotoxic T-lymphocyte antigen 4, programmed death 1, or combinatorial b...Continue Reading

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Citations

Apr 18, 2020·Neurosurgery·Elisa Aquilanti, Priscilla K Brastianos
Apr 22, 2020·Neurosurgery·Cecilia JiangMohammad K Khan
Mar 30, 2020·Journal for Immunotherapy of Cancer·Teresa AmaralUNKNOWN *German Dermatological Cooperative Oncology Group
Oct 27, 2020·The Oncologist·Edwin Nieblas-BedollaPriscilla K Brastianos
Jan 5, 2021·Neuro-oncology Advances·Joseph P MerolaCaroline Hayhurst
Apr 25, 2021·Brain : a Journal of Neurology·Jawad FaresMaciej S Lesniak
Aug 9, 2021·Annals of Oncology : Official Journal of the European Society for Medical Oncology·E Le RhunUNKNOWN EANO Executive Board and ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org

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