LINAC-based stereotactic radiosurgery to the brain with concurrent vemurafenib for melanoma metastases
Kamran A Ahmed1, Jessica M Freilich, Sarah Sloot
1Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA, kamran.ahmed@moffitt.org.
Abstract:
While selective BRAF inhibitors have demonstrated improved outcomes in patients with metastatic BRAF V600E mutant melanoma, management of brain metastases prior to and during therapy presents challenges. Stereotactic radiosurgery (SRS) is an effective treatment for melanoma brain metastases, but there is limited safety and efficacy data on the use of SRS during BRAF therapy. An analysis was performed of patients with metastatic melanoma and brain metastases treated with SRS while on vemurafenib. MRI scans were reviewed post-SRS to evaluate local control (LC) as well as distant control. We identified 80 metastatic melanoma brain lesions treated in 24 patients. The median planning target volume was 0.28 cm(3) (range 0.05-4.19 cm(3)), and lesions were treated to a median dose of 24 Gy (range 15-24 Gy). The median follow up was 5.1 months (range 2-25.2 months). Eight (10 %) lesions showed progression at a median of 6.1 months (range 2-20.1 months) following SRS. Kaplan-Meier LC estimates at 6 and 12 months were 92 and 75 %, respectively. Fourteen (58 %) patients were noted to have distant brain failure at a median of 3.4 months (range 1.9-16.1 months) following treatment with SRS. Median overall (OS) from the date of SRS was 7.2 months (range 1.5-26.8 months) with a median of 11.9 months (range 1.5-28.5 months) since the date of brain metastases diagnosis. There was no evidence of increased toxicity with the combination of SRS and vemurafenib. SRS to brain metastases appears to be both safe and effective for patients treated concurrently with BRAF inhibitors.
Insights
Stereotactic radiosurgery (SRS) combined with BRAF inhibitor therapy is safe and effective for treating melanoma brain metastases. This approach shows promising local control rates and manageable toxicity in patients with BRAF V600E mutant melanoma.
Area of Science:
- Oncology
- Neurosurgery
- Radiotherapy
Background:
- Metastatic melanoma with BRAF V600E mutation shows improved outcomes with BRAF inhibitors.
- Brain metastases management remains challenging during BRAF inhibitor therapy.
- Stereotactic radiosurgery (SRS) is effective for brain metastases, but safety with concurrent BRAF therapy is unclear.
Purpose of the Study:
- To evaluate the safety and efficacy of SRS for melanoma brain metastases in patients receiving vemurafenib.
- To assess local control (LC) and distant brain failure after SRS during BRAF therapy.
Main Methods:
- Retrospective analysis of 24 patients with metastatic melanoma and brain metastases treated with SRS while on vemurafenib.
- Review of MRI scans post-SRS for local and distant disease control.
- Evaluation of toxicity associated with combined SRS and vemurafenib treatment.
Main Results:
- 80 lesions were treated with SRS; 10% showed progression post-SRS.
- Kaplan-Meier estimates for LC at 6 and 12 months were 92% and 75%, respectively.
- 58% of patients experienced distant brain failure; no increased toxicity observed with combined therapy.
Conclusions:
- SRS is a safe and effective treatment for melanoma brain metastases when used concurrently with BRAF inhibitors like vemurafenib.
- The combination therapy demonstrates good local control and acceptable toxicity profiles.
- Further research may support SRS as a standard treatment option in this patient population.
