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ASCO 2019: Whole-Brain Radiation vs. Observation for Melanoma Brain Metastases

By: Joseph Fanelli
Posted: Wednesday, June 5, 2019

According to phase III international trial results, presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 9500), whole-brain radiotherapy does not seem to improve outcomes for patients with melanoma brain metastases. The open-label study focused on the impact of whole-brain radiation versus observation after local treatment of one to three intracranial melanoma brain metastases, concluded Gerald Fogarty, MD, PhD, of the Melanoma Institute of Australia and The University of Sydney, Australia, and colleagues.

“This practice-changing trial justifies the recent move away from [whole-brain radiotherapy] that occurred during the course of the trial,” the authors concluded.

The authors randomly assigned patients with one to three melanoma brain metastases to observation (107 patients) or whole-brain radiotherapy (100). All study patients had received local treatment with either surgical excision and/or stereotactic irradiation. A total of 61% had a single a brain metastasis, with a mean size of 2 cm, and 67% had extracranial disease at randomization.

Within 12 months, 54 patients (50.5%) in the observation cohort experienced distant intracranial failure, compared with 42 patients (42%) in the whole-brain radiotherapy group. The authors found no difference in local failure (P = .100) or overall survival (log-rank P = .861) between the two cohorts. At 12 months, 53% of the patients in the observation pool remained alive, and 59% of the radiotherapy cohort remained alive.

Furthermore, patients in the observation group had greater relative improvement from baseline in Hopkins Verbal Learning Test–Revised at every time point within the trial. At 4 months, those patients experienced a 20.9% improvement from baseline in Hopkins Verbal Learning Test–Revised delayed recall, compared with a 2.7% decline in those who received whole-brain radiotherapy.

Disclosure: The study authors’ disclosure information may be found at coi.asco.org.



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