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Ye W, Kim M, Fairfax BP, Coupe N, Payne MJ, Matin RN. Phenotyping of cutaneous toxicities in patients with metastatic malignant melanoma treated with immune checkpoint blockade therapy at a UK tertiary care centre. Clin Exp Dermatol 2021; 47:448-450. [PMID: 34610165 DOI: 10.1111/ced.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 12/01/2022]
Affiliation(s)
- W Ye
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK.,Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Kim
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - B P Fairfax
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,The MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - N Coupe
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M J Payne
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R N Matin
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Webb PS, Zorman M, Watson R, Payne M, Coupe N, Hobbs C. P14.29 The treatment of melanoma brain metastases with stereotactic radiosurgery concurrently with immune checkpoint inhibition is associated with improved extracranial disease control and overall survival compared to the overall metastatic melanoma cohort - a synergistic effect reaching beyond local control? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Melanoma brain metastases (MBM) are an increasingly common referral to the neuro-oncology MDT in the context of lengthening survivorship of metastatic melanoma (MM) patients in the immunotherapy era. Stereotactic radiosurgery (SRS) and immune checkpoint inhibition (ICI) are both effective in the management of MBM and, when combined, 12-month local control rates of >85% and overall survival (OS) >80% have been reported.[4,5] Recent local analysis of patients treated at our tertiary SRS referral centre has revealed even greater outcomes in this patient cohort. This study aimed to compare the outcomes of patients with MBM treated with concurrent SRS and ICI compared to the overall metastatic melanoma cohort, to elucidate whether the addition of SRS to ICI may improve disease control outside of the brain as well as within.
MATERIAL AND METHODS
A retrospective analysis of our local SRS database and an ARIA ePrescribing database search was performed to identify a cohort of patients treated with concurrent SRS and ICI for MBM, as well as a control cohort of MM patients who received ICI alone, over a 4 year period until February 2020. The primary endpoints were the extracranial progression free survival (PFS) and overall survival (OS) at 12 months. Secondary endpoints were the median PFS (mPFS) and OS (mOS). Kaplan-Meier curves and survival statistics were generated using SPSS v26.
RESULTS
A total of 34 MBM from 19 patients were identified in the SRS+ICI group and there were 200 patients in the control group. The minimum follow up was 12 months. The median patient age, duration of ICI and use of combination ICI favoured the SRS+ICI group. The number of sites of extracranial disease pre-ICI and overall anti-PD-1 usage was well matched. In the SRS+ICI group, there were no cases of extracranial progression and no deaths within 12 months. In the control group, the 12-month PFS and OS rates were 50.5% and 77.5% respectively. In terms of mPFS, this was not reached (estimated 37.6 months) in the SRS+ICI group, versus 13.4 months in the control group (log rank test, p=0.001). In terms of mOS, this was not reached in the SRS+ICI group, versus 55.8 months in the control group (log rank test, p=0.016).
CONCLUSION
We demonstrate improved extracranial disease control and survivorship amongst metastatic melanoma patients who develop brain metastases and are treated with concurrent SRS and ICI compared to those who do not. The outcomes of our control cohort are comparable to the 4-year follow up of the CheckMate 067 trial (n=945),[6] which strengthens the validity of the statistical comparisons made in this study. The improved extracranial disease control seen when SRS and ICI are combined in the treatment of MBM questions whether an abscopal effect may be at play, and therefore further accents the utility of SRS in MBM beyond that of local control alone. This could influence management in cases of borderline decisions for SRS.
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Affiliation(s)
- P S Webb
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - M Zorman
- Buckinghamshire Healthcare NHS Trust, Bucks, United Kingdom
| | - R Watson
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - M Payne
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - N Coupe
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C Hobbs
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Lloyd-Lavery A, Hodgson T, Coupe N, Bond S, Shah K, Espinosa O, Payne M, Middleton M, Matin R. Delayed oral toxicity from long-term vemurafenib therapy. Br J Dermatol 2016; 174:1159-60. [DOI: 10.1111/bjd.14457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Lloyd-Lavery
- Department of Dermatology; Churchill Hospital; Oxford University Hospitals NHS Trust; Old Road Oxford OX3 7LE U.K
| | - T. Hodgson
- Department of Oral Medicine; Eastman Dental Hospital; University College London Hospitals NHS Foundation Trust; London U.K
| | - N. Coupe
- Department of Oncology; Churchill Hospital; Oxford University Hospitals NHS Trust; Old Road Oxford OX3 7LE U.K
| | - S. Bond
- Department of Oral Surgery; John Radcliffe Hospital; Oxford University Hospitals NHS Trust; Oxford U.K
| | - K. Shah
- Department of Histopathology; John Radcliffe Hospital; Oxford University Hospitals NHS Trust; Oxford U.K
| | - O. Espinosa
- Department of Histopathology; John Radcliffe Hospital; Oxford University Hospitals NHS Trust; Oxford U.K
| | - M.J. Payne
- Department of Oncology; Churchill Hospital; Oxford University Hospitals NHS Trust; Old Road Oxford OX3 7LE U.K
| | - M.R. Middleton
- Department of Oncology; Churchill Hospital; Oxford University Hospitals NHS Trust; Old Road Oxford OX3 7LE U.K
| | - R.N. Matin
- Department of Dermatology; Churchill Hospital; Oxford University Hospitals NHS Trust; Old Road Oxford OX3 7LE U.K
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Coupe N, Corrie P, Hategan M, Larkin J, Gore M, Gupta A, Wise A, Suter S, Ciria C, Love S, Collins L, Middleton M. A Phase 1, Dose Escalation Study of Paclitaxel with Gsk1120212 (Trametinib) for the Treatment of Advanced Melanoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu344.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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