Journal article
Improved Survival and Prognostication in Melanoma Patients With Brain Metastases: An Update of the Melanoma Graded Prognostic Assessment
Journal of clinical oncology, Vol.43(16), pp.1910-1919
06/2025
DOI: 10.1200/JCO-24-01351
PMCID: PMC12119226
PMID: 40245362
Abstract
Survival for patients with melanoma has recently improved. The propensity of melanoma to metastasize to the brain remains a common and serious feature of this disease. The purposes of this study were to evaluate prognostic factors for patients with newly diagnosed melanoma brain metastases (MBMs) in a large cohort treated with modern multimodal therapies, compare those results with those in prior eras, and update the Melanoma Graded Prognostic Assessment (GPA).
Univariable and multivariable (MVA) analyses of prognostic factors and treatments associated with survival were performed on 1,796 patients with newly diagnosed MBM treated between January 01, 2015, and December 31, 2021, using a multi-institutional retrospective database. Multiple imputation was used to address missingness of potential predictors. Significant variables in combined MVA were used to update the Melanoma GPA. Comparisons were made with legacy cohorts.
Median survivals for cohorts A (1985-2007, n = 481), B (2006-2015, n = 823), and C (2015-2021, n = 1,796) were 6.7, 9.8, and 16.6 months and median follow-up times were 40.1, 43.6, and 48.8 months, respectively. In combined MVA, significant prognostic factors for survival were higher Karnofsky Performance Status, fewer MBMs, absence of extracranial metastases, lower serum lactate dehydrogenase, and no immunotherapy before MBM. These factors were incorporated into the updated Melanoma GPA. The combined median and 3-year survivals for patients with GPA 0-1, 1.5-2, and 2.5-4.0 were 5.4, 13.2, and 43.2 months and 12.4%, 28.8%, and 51.6%, respectively.
Prognostic factors have changed and survival has improved for patients with MBM but varies widely by GPA. The updated Melanoma GPA calculator (BrainMetGPA), available free online, can be used to estimate survival, individualize treatment, stratify clinical trials, guide surveillance, and augment clinical trial eligibility. Multidisciplinary treatment is essential. Trials are needed to elucidate the optimal sequencing of various therapeutic modalities.
Details
- Title: Subtitle
- Improved Survival and Prognostication in Melanoma Patients With Brain Metastases: An Update of the Melanoma Graded Prognostic Assessment
- Creators
- Paul W Sperduto - Duke UniversityKathryn E Marqueen - The University of Texas MD Anderson Cancer CenterEnoch Chang - The University of Texas MD Anderson Cancer CenterJing Li - The University of Texas MD Anderson Cancer CenterMichael A Davies - The University of Texas MD Anderson Cancer CenterDaniel K Ebner - Mayo ClinicWilliam G Breen - Mayo ClinicNayan Lamba - Massachusetts General HospitalHelen A Shih - Massachusetts General HospitalDonna Edwards - University of MichiganMichelle M Kim - University of MichiganAmandeep Mahal - Brigham and Women's HospitalRifaquat Rahman - Brigham and Women's HospitalNii Ankrah - University of AlabamaDrexell H Boggs - University of AlabamaCalvin Lewis - University of Iowa, Iowa City, IADaniel Hyer - University of Iowa, Iowa City, IAJohn M Buatti - University of Iowa, Iowa City, IAFasila Johri - University of TorontoHany Soliman - University of TorontoLaura Masucci - Centre Hospitalier de l’Université de MontréalDavid Roberge - Centre Hospitalier de l’Université de MontréalSanjay Aneja - University of New HavenVeronica Chiang - University of New HavenChristina Phuong - University of California, San FranciscoSteve Braunstein - University of California, San FranciscoSalah Dajani - Northwestern UniversitySean Sachdev - Northwestern UniversityZihan Wan - Duke Cancer InstituteDonna Niedzwiecki - Duke Cancer InstituteEugene Vaios - Duke UniversityJohn P Kirkpatrick - Duke UniversityJared Pasetsky - Columbia UniversityTony J C Wang - Columbia UniversityTugce Kutuk - Baptist Health South FloridaRupesh Kotecha - Baptist Health South FloridaRichard B Ross - 7University of Colorado School of Medicine, Aurora, COChad G Rusthoven - 7University of Colorado School of Medicine, Aurora, COToshimichi Nakano - 8University of Niigata, Niigata, JapanHussein A Tawbi - The University of Texas MD Anderson Cancer CenterMinesh P Mehta - Baptist Health South Florida
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.43(16), pp.1910-1919
- DOI
- 10.1200/JCO-24-01351
- PMID
- 40245362
- PMCID
- PMC12119226
- NLM abbreviation
- J Clin Oncol
- ISSN
- 1527-7755
- eISSN
- 1527-7755
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Grant note
- NIH: NCI P30CA014236 Duke Center for Brain and Spine Metastases
Supported in part by grants from NIH (NCI P30CA014236) and Duke Center for Brain and Spine Metastases. This support was used for database management and statistical analyses.
- Language
- English
- Electronic publication date
- 04/17/2025
- Date published
- 06/2025
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiation Oncology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984811215002771
Metrics
22 Record Views