Impact of radiotherapy administered simultaneously with systemic treatment in patients with melanoma brain metastases within MelBase, a French multicentric prospective cohort

Autor: Stéphane Dalle, Raphaël Porcher, Thierry Lesimple, Marie-Thérèse Leccia, Jean-Philippe Lacour, Sophie Dalac, D. Legoupil, Pauline Tétu, Sameh Mohamed, A. Ballon, Florence Brunet-Possenti, Céleste Lebbé, Clara Allayous, Laurent Mortier, François Aubin, Julie De Quatrebarbes, Pierre-Emmanuel Stoebner, Caroline Dutriaux, Bastien Oriano, Brigitte Dréno, Bernard Guillot, Philippe Saiag, Marie Beylot-Barry
Přispěvatelé: Immunologie humaine, physiopathologie & immunothérapie (HIPI (UMR_S_976 / U976)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre de Diagnostic et de Thérapeutique, Hôpital de l’Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire de Cytogénétique Constitutionnelle [Hospices civils de Lyon], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Dermatologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Bordeaux [Bordeaux], Service de Dermatologie [Nice], Hôpital Archet 2 [Nice] (CHU), Hôpital Ambroise Paré [AP-HP], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital Morvan - CHRU de Brest (CHU - BREST ), Centre Eugène Marquis (CRLCC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre hospitalier universitaire de Nantes (CHU Nantes), Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) (SBIM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut national du cancer [Boulogne] (INCA)-Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), CCSD, Accord Elsevier
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
Oncology
Cancer Research
medicine.medical_specialty
genetic structures
Propensity score
medicine.medical_treatment
[SDV.CAN]Life Sciences [q-bio]/Cancer
Systemic therapy
Targeted therapy
03 medical and health sciences
0302 clinical medicine
[SDV.CAN] Life Sciences [q-bio]/Cancer
Internal medicine
medicine
Humans
Prospective Studies
cardiovascular diseases
Stage (cooking)
Prospective cohort study
Melanoma
Aged
Proportional Hazards Models
Radiotherapy
Brain Neoplasms
business.industry
MESH: Brain Neoplasms/radiotherapy
Melanoma/drug therapy
Melanoma/radiotherapy
Middle Aged
Brain metastases
medicine.disease
equipment and supplies
Advanced melanoma
Combined Modality Therapy
Confidence interval
3. Good health
Radiation therapy
030104 developmental biology
030220 oncology & carcinogenesis
Propensity score matching
cardiovascular system
Female
Immunotherapy
business
circulatory and respiratory physiology
Zdroj: European Journal of Cancer
European Journal of Cancer, Elsevier, 2019, 112, pp.38-46. ⟨10.1016/j.ejca.2019.02.009⟩
European Journal of Cancer, 2019, 112, pp.38-46. ⟨10.1016/j.ejca.2019.02.009⟩
ISSN: 0959-8049
DOI: 10.1016/j.ejca.2019.02.009⟩
Popis: International audience; Background: Melanoma brain metastases (MBMs) are historically associated with poor prognosis. Radiation therapy is conventionally associated with a high local control rate. Development of targeted therapy and immunotherapy has improved overall survival (OS) and intracranial response rate, but about 50% of patients failed to respond to these novel therapies. The objective of this study was to assess the impact of combined radiotherapy (cRT) on overall survival in a large multicenter real-life prospective cohort of patients with MBM treated with immunotherapy or targeted therapy.Patients and methods: Clinical data from 262 patients with MBM were collected via MelBase, a French multicentric biobank prospectively enrolling unresectable stage III or IV melanoma. Two groups were defined: patients receiving cRT (cRT group) or not receiving cRT (no-cRT group). Primary end-point was OS. Propensity score weighting was used to correct for indication bias.Results: Among the 262 patients, 93 (35%) received cRT (cRT group). The patients were treated with immunotherapy in 69% and 60% and with targeted therapy in 31% and 40% of the cRT and no-cRT groups, respectively. With a median follow-up of 6.9 months, median OS was 16.8 months and 6.9 months in the cRT and no-cRT groups, respectively. After propensity score weighting, cRT was associated with longer OS (hazard ratio = 0.6, 95% confidence interval: 0.4-0.8; p=0.007). Median OS after ponderation was 15.3 months and 6.2 months in the cRT and no-cRT groups, respectively.Conclusion: This study shows that cRT may be associated with a significant decrease of 40% in the risk of death in patients with MBM treated with systemic therapy.
Databáze: OpenAIRE
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