Gaudy-Marqueste C, et al. - This study was undertaken to assess the survival of melanoma patients treated with targeted therapy and immunotherapy after systematic upfront control of brain metastases by radiosurgery. As per findings, in real-life metastatic melanoma (MM) patients (pts) with brain metastasis (BM), a strategy aiming at controlling BM with Gamma-Knife (GK) together with targeted therapy (TT) and/or TT might achieve unprecedented survival rates.

Methods

• This study included retrospective cohort of consecutive MM patients (pts) with BMs, all systematically upfront treated by Gamma-Knife (GK) at first BM and retreated in case of new BMs, from 2010 to 2015 at the time when ipilimumab BRAF ± MEK inhibitors and anti-PD1 were introduced in practice.
• Researchers assessed survival after 1st GK (OS_GK1) according to prognostic factors and treatment.

Results

• 179 consecutive pts were treated by GK, 109/179 received IT and/or TT after the 1st GK.
• Observations revealed median OS_GK1 of 10.95 months and 1- and 2-year survival rates of 49.5% and 27.4%, respectively, versus a median overall survival (OS) of 2.29 months (p < .001) in those who did not receive IT or TT.
• Pts indicating a single BM at initial phase showed median OS and 1- and 2-year survival rates of 14.46 months, 66.7% and 43.4%, respectively; pts with 2–3 BMs showed: 8.85 months, 46.4% and 31%, respectively; pts with >3 BMs showed: 7.25 months, 37.2% and 11.9%, respectively.
• Findings from multivariate analysis for OS_GK1 supported that IT and TT were significantly and highly protective.
• In this study, best OS_GK1 was observed in BRAF–wild-type pts receiving anti-PD1 or in BRAF-mutated pts receiving BRAF-inhibitors and anti-PD1 (12.26 and 14.82 months, respectively).