Research presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting suggested that patients with melanoma brain metastases (MBMs) should not be treated with adjuvant whole-brain radiotherapy (WBRT).
It is currently unknown whether patients with 1-3 MBMs ought to receive WBRT or undergo observation only after local treatment. For this randomized phase 3 trial (ClinicalTrials.gov Identifier: NCT01503827), researchers evaluated which approach was optimal, using 12-month distant intracranial failure (DIF) and neurocognitive function (NCF) at 4 months as the primary end points. Secondary end points included local failure, overall survival, and global quality of life.
Of 215 patients enrolled between 2009 and 2017, 8 did not have data or withdrew from the study; data being presented at ASCO were for the 207 patients who were randomly assigned to observation (107) or WBRT (100). The mean patient age was 62 years and 67% of patients were male.
At 12 months, 42 (42%) patients who received WBRT and 20 (50.5%) patients in the observation group had DIF (subdistribution hazard ratio [HR] 1.28; 95% CI, 0.89-1.84).
Secondary end points were not significantly different between the 2 groups, including overall survival; 58.4% of WBRT patients and 54% of observation patients were still alive at 1 year.
“This level-one evidence shows WBRT does not improve outcomes in MBMs,” the authors wrote. “This practice-changing trial justifies the recent move away from WBRT that occurred during the course of the trial.” The researchers added that the results were not in line with previous WBRT trials.
Fogarty G, Dolven-Jacobsen K, Morton RL, et al. Phase 3 international trial of adjuvant whole brain radiotherapy (WBRT) or observation (Obs) following local treatment of 1-3 melanoma brain metastases (MBMs). Presented at: 2019 American Society of Clinical Oncology (ASCO) Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract 9500.
This article originally appeared on Cancer Therapy Advisor