Improved Survival with Immunotherapy but Lack of Synergistic Effect with Radiation for Stage IV Melanoma of the Head and Neck

2019 ◽  
Vol 85 (10) ◽  
pp. 1118-1124
Author(s):  
Blake Babcock ◽  
Medora Rodrigues ◽  
Donovan Kearns ◽  
Naveenraj Solomon ◽  
Mark E. Reeves ◽  
...  
Keyword(s):  
Overall Survival ◽  
Synergistic Effect ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Survival Benefit ◽  
Retrospective Studies ◽  
Cox Regression ◽  
Stage Iv ◽  
National Cancer Database ◽  
Stage Iv Melanoma

Prospective randomized studies have demonstrated a survival benefit of immunotherapy in stage IV cutaneous melanoma. Some retrospective studies have hypothesized a synergistic effect of radiation and immunotherapy. Our objective was to identify whether there is a survival benefit for patients treated with radiation and immunotherapy in stage IV cutaneous melanoma of the head and neck (CMHN). The National Cancer Database was used to identify patients with stage IV CMHN between 2012 and 2014. These patients were stratified based on receipt of radiation and immunotherapy. Adjusted Cox regression was used to analyze overall survival. A total of 542 patients were identified with stage IV CMHN, of whom 153 (28%) patients received immunotherapy. Receipt of immunotherapy (hazard ratio [HR] 0.69, P = 0.02) and negative LNs (HR 0.50, P = 0.002) were independently associated with improved survival, whereas radiation conferred no survival benefit (HR 1.17, P = 0.26). Patients who received immunotherapy without radiation were associated with significantly improved survival compared with those who received immunotherapy with radiation ( P < 0.0001). However, of patients who received radiation, the addition of immunotherapy did not seem to improve survival ( P = 0.979). In stage IV CMHN, immunotherapy confers a 32 per cent survival benefit. The use of immunotherapy in patients who require radiation, however, is not associated with improved survival.

Surgery provides survival benefit over systemic therapy alone for stage IV triple negative breast cancer: A propensity matched analysis of the National Cancer Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13054-e13054
Author(s):  
Lifen Cao ◽  
Jonathan T. Bliggenstorfer ◽  
Kavin Sugumar ◽  
Christopher W. Towe ◽  
Pamela Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Triple Negative ◽  
Stage Iv ◽  
National Cancer Database ◽  
Propensity Matching ◽  
N Stage ◽  
Metastatic Sites

e13054 Background: Conflicting data exist regarding benefit of surgery of the primary site for stage IV breast cancer, in which systemic therapy is standard of care and patient characteristics may bias treatment decisions. Metastatic triple negative breast cancer (TNBC) is an aggressive subtype with limited therapy options and poor prognosis. Our aim was to assess whether surgery for the primary tumor in stage IV TNBC provides a survival advantage over systemic therapy alone. Methods: The National Cancer Database was queried for patients with de-novo stage IV TNBC who received systemic therapy alone or systemic therapy and surgery of the primary breast site 2004-2016. Patients receiving surgery for metastatic tumor sites or with incomplete follow up data were excluded. 1:1 propensity matching was performed for demographics, comorbidities, clinical T and N stage, and metastatic sites to minimize confounding factors. Survival outcomes were analyzed using a stratified log-rank test and Cox proportional hazard regression analysis. Results: Of 2989 patients, 782 (26.21%) underwent surgery plus systemic therapy and 2207 (73.84%) were treated with systemic therapy alone. The majority of all patients were aged 51-70 with low co-morbidity, and treated in metropolitan areas. Patients treated at academic facilities (OR = 0.67, p = 0.025), with multiple metastatic sites (OR = 0.59, p < 0.001), or advanced clinical N stage (OR = 0.55, p < 0.001) were less likely to undergo surgery. Of those who completed surgery, 58% had unilateral mastectomy, and 63% had axillary lymph node dissection. Propensity matching identified 507 ‘paired’ patients with similar characteristics in the surgery and systemic therapy alone groups. After multivariable adjustment, surgery was associated with superior overall survival compared with systemic therapy alone (HR 0.73, P < 0.001). Older age (HR = 1.47, p < 0.001), greater comorbidity (HR = 1.28, p < 0.001) and multiple metastatic sites (HR = 1.53, p < 0.001) significantly decreased overall survival in the matched cohort. Median survival was shortest in the systemic therapy alone group (12.8 months, 95% CI 11.3-14.5) and longest in those undergoing systemic therapy plus simple mastectomy (18 months, 95% CI 14.3-21.2), though approximately 4 months of median survival was added for all patients undergoing any surgery vs. systemic therapy alone (p = 0.0001). Conclusions: In stage IV TNBC, surgical resection of the primary tumor site in addition to systemic therapy may provide a survival benefit in selected patients. Though in this retrospective study the sequence of treatment was unknown, surgery could be considered for low disease burden as in other malignancies with oligometastatic disease. Additional research is needed to determine if these findings persist in prospective studies and for other hormone-receptor subtypes.

Treatment outcomes in melanoma with brain metastases in the era of immunotherapy: An analysis of the National Cancer Database.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14513-e14513
Author(s):  
Justin Moyers ◽  
Esther G Chong ◽  
Daniel Sufficool ◽  
Gayathri Nagaraj
Keyword(s):  
Brain Metastases ◽  
Treatment Outcomes ◽  
Metastatic Melanoma ◽  
Survival Data ◽  
Survival Benefit ◽  
Stage Iv ◽  
Rank Test ◽  
National Cancer Database ◽  
Single Modality ◽  
Stage Iv Melanoma

e14513 Background: Brain metastases (BM) are a major cause of morbidity and mortality in metastatic melanoma. Radiotherapy (RT) and/or surgery are the standard of care for treating brain metastases. The introduction of immune checkpoint inhibitors has drastically improved disease outcomes since approved in 2011 and recent trials have exhibited intracranial activity. We aim to assess the added survival benefit of immuno-oncologic agents (IO) for melanoma with BM in National Cancer Database. Methods: We queried the database from 2011 to 2015 for Stage IV melanoma with BM. RT treatments were divided into stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT), or no brain radiation; those with insufficient documentation were excluded. Patients were further divided into receipt of IO or no receipt of IO; those without documentation were excluded. Concurrent (CC) treatment was defined as IO begun before or during RT treatment; sequential (SQ) therapy was defined as IO begun after RT. Survival analyses were performed by Kaplan-Meier method and log-rank test. Results: Among 8,561 metastatic melanoma patients with documentation of metastatic sites, 3,008 (35.1%) had documented BM. Median overall survival (mOS) for all stage IV melanoma was 10.5 months with worse survival for those with BM compared to those without (mOS 6.0 v 14.7 m; p < 0.01). Among 3,008 cases with survival data available, 2,762 met criteria for survival analysis of BM treatments. Table summarizes treatment outcomes between cohorts by RT and IO treatment categories. IO + SRS had improved survival compared to all other treatment groups (mOS 19.9 m; p < 0.01). No difference in survival between SRS and IO alone was observed (mOS 10.9 v 11.5 m; p = 0.56). WBRT as single modality did not appear to improve survival over no therapy (mOS 4.2 v 3.3 m; p = 0.35). 436 cases had documented time course between IO and RT. IO was given SQ with RT in 69% of SRS (n = 158/230) and 67% of WBRT (n = 137/206) treated patients. In SRS + IO cohort, survival was longer for SQ compared to CC treatment (23.5 v 13.1 m; p < 0.01). Survival was similar in WBRT for SQ v CC groups (6.8 v 7.9 m; p = 0.62). Conclusions: Superior survival is realized for those who receive IO in addition to SRS for BM. IO and SRS as single modality have similar outcomes, while WBRT seems to add little survival benefit to IO or no therapy. [Table: see text]

Patterns of Care and Survival of Cutaneous Angiosarcoma of the Head and Neck

2020 ◽  
Vol 162 (6) ◽  
pp. 881-887 ◽  
Author(s):  
Clifford Chang ◽  
S. Peter Wu ◽  
Kenneth Hu ◽  
Zujun Li ◽  
David Schreiber ◽  
...  
Keyword(s):  
Head And Neck ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Multimodality Treatment ◽  
The Elderly ◽  
Hazard Ratio ◽  
Patterns Of Care ◽  
Definitive Treatment ◽  
National Cancer Database ◽  
Curative Intent

Objective To analyze the patterns of care and survival of cutaneous angiosarcomas of the head and neck. Study Design Retrospective cohort study. Setting National Cancer Database. Methods The National Cancer Database was queried to select patients with cutaneous angiosarcoma of the head and neck between 2004 and 2015. For survival analysis, patients were included only if they received definitive treatment and complete data. Prognostic factors were analyzed by univariate and multivariable Cox regression. Results We identified 693 patients diagnosed with head and neck angiosarcomas during the study period. The majority were male (n = 489, 70.6%) and elderly (median, 77 years). A total of 421 patients (60.8%) met the criteria for survival analyses. These patients were treated with surgery and radiation (n = 178, 42.3%), surgery alone (n = 138, 32.8%), triple-modality therapy (n = 48, 11.4%), surgery and chemotherapy (n = 29, 6.9%), and chemoradiation (n = 28, 6.7%). With a median follow-up of 29 months, the 3-year survival was 50.1%. Patients undergoing surgery had better median survival than those who did not (38.1 vs 21.0 months, P = .04). Age, comorbidity, tumor size, and surgical margins were significant factors in univariate analyses. On multivariable analysis, age ≥75 years (hazard ratio, 2.65; 95% CI, 1.80-3.88; P < .001) and positive margins (hazard ratio, 1.91; 95% CI, 1.44-2.51; P < .001) predicted worse overall survival. Conclusion Angiosarcoma of head and neck is a rare malignancy that affects the elderly. Surgical treatment with negative margins is associated with improved survival. Even with curative-intent multimodality treatment, the survival of patients aged ≥75 years is limited.

scholarly journals Opposite roles of BAP1 in overall survival of uveal melanoma and cutaneous melanoma

2019 ◽  
Author(s):  
Feng Liu-Smith
Keyword(s):  
Overall Survival ◽  
Uveal Melanoma ◽  
Cutaneous Melanoma ◽  
Cox Regression ◽  
Survival Function ◽  
Poor Overall Survival ◽  
Cox Regression Analysis ◽  
Oncogenic Pathways ◽  
Cellular Context ◽  
Age Of Diagnosis

Abstract Background: BAP1 germline mutations predispose individuals to a number of cancer types including uveal melanoma (UM) and cutaneous melanoma (CM) which are distinctively different in the oncogenic pathways. BAP1 loss was common in UM and was associated with a worse prognosis. BAP1 loss was rare in CM and the outcome was unclear. Methods: This study used TCGA UM and CM databases for survival analysis for patients with different BAP1 status and mRNA expression levels. Cox regression model was used for adjusting to known prognosis factors. Results: BAP1- (loss or low expression) predicted a poor overall survival in UM (Cox HR = 0.062, logrank p =0.007) but a contrasting better overall survival in CM (HR = 1.69, p =0.009). Multi-covariate Cox regression analysis indicated BAP1 was a significant predictor for overall survival after adjusting for age of diagnosis, presence of ulceration, Breslow depth and CM stages in patients older than 50 years but not in younger patients. Co-expression analysis revealed no shared genes in BAP1 altered UM and CM tumors, further supporting a completely distinctive role of BAP1 in CM and UM. Conclusions: low BAP1 mRNA was significantly associated with a better overall survival in CM patients, in sharp contrast to its tumor suppressor role in UM where low or loss of BAP1 indicated a worse overall survival. Function of BAP1 may be dependent on cellular context.

A National Cancer Database analysis of the patterns of care for meningeal melanocytoma

2021 ◽  
Author(s):  
Amanda C Tep ◽  
Patrick D Kelly ◽  
Daphne B Scarpelli ◽  
Bailey Bergue ◽  
Shearwood McClelland III ◽  
...  
Keyword(s):  
Overall Survival ◽  
Patient Outcomes ◽  
Cox Regression ◽  
Treatment Patterns ◽  
National Cancer Database ◽  
Regression Analyses ◽  
Database Analysis ◽  
Meningeal Melanocytoma ◽  
Kaplan Meier ◽  
Poor Treatment

Aim: To evaluate demographics, treatment patterns, radiotherapy utilization and patient outcomes in meningeal melanocytomas. Materials & methods: The National Cancer Database was queried for meningeal melanocytomas diagnosed in 2002–2016. The effects of demographic, clinical and treatment variables were determined via Kaplan–Meier log-rank and Cox regression analyses. Results: The median and 5-year overall survival were 57.46 months and 48%, respectively. Patients earning ≥ $48K showed improved survival (p = 0.0319). Radiotherapy and chemotherapy were utilized in 37.7 and 9% of patients, respectively. Conclusion: Income significantly affected survival. Surgery remains the mainstay approach. Radiotherapy was delivered in more than one-third of patients but did not impact survival. However, further analyses were limited by poor treatment modality information in the database.

Commission on Cancer CP3R Compliance Rates for Treatment of Patients With Triple Negative and HER2+ Breast Cancer: A National Cancer Database Analysis

2021 ◽  
pp. 000313482110516
Author(s):  
Srivarshini C. Mohan ◽  
Joshua Tseng ◽  
Marissa Srour ◽  
Alice Chung ◽  
Ashley Marumoto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Quality Care ◽  
Private Insurance ◽  
National Cancer Database ◽  
Database Analysis ◽  
Her2 Breast Cancer ◽  
Academic Hospitals ◽  
Multi Agent

Background Cancer Program Practice Profile Reports (CP3R) metrics were released by the Commission on Cancer to provide standards for high-quality care. One metric is the recommendation of combination chemotherapy or chemo-immunotherapy (CIT) within 120 days of diagnosis for women under 70 with AJCC T1cN0M0 or Stage IB-III HER2+ or hormone receptor negative breast cancer ([Multi-agent chemotherapy] MAC). Our study assesses national concordance rates for MAC and CIT. Methods The National Cancer Database was queried from 2004-2014. Results 122,045 patients met criteria, of whom treatment for 101,800 (83.4%) patients was concordant with MAC and CIT. Treatment concordance increased from 75.7% in 2004 to 89.5% in 2014. For HER2+ patients, use of CIT treatment downtrended with progression of pathological stage, from 70.1% (stage I) to 58.1% (stage III). Mean overall survival of patients whose treatment was concordant with MAC and CIT was longer than that of patients who were non-concordant (146.6 vs 143.8 months, P <.01). On Cox regression, there was a survival benefit for concordant patients who were treated at academic hospitals (HR .89, 95% CI 0.802-.976) and had private insurance (HR .76, 95% CI 0.65-.89). Conclusion Compliance with MAC and CIT has improved over the past decade and is associated with a significant improvement in overall survival.

Prolonged overall survival following metastasectomy in stage IV melanoma

2019 ◽  
Vol 33 (9) ◽  
pp. 1719-1725 ◽  
Author(s):  
M.L. Elias ◽  
S. Behbahani ◽  
S. Maddukuri ◽  
A.M. John ◽  
R.A. Schwartz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stage Iv ◽  
Stage Iv Melanoma

scholarly journals Opposite Roles of BAP1 in Overall Survival of Uveal Melanoma and Cutaneous Melanoma

2020 ◽  
Vol 9 (2) ◽  
pp. 411 ◽  
Author(s):  
Feng Liu-Smith ◽  
Yunxia Lu
Keyword(s):  
Overall Survival ◽  
Uveal Melanoma ◽  
Cutaneous Melanoma ◽  
Cox Regression ◽  
Enrichment Analysis ◽  
Copy Number Variations ◽  
The Cancer Genome Atlas ◽  
Small Subset ◽  
Mrna Levels ◽  
Cancer Genome Atlas

Background: BRCA1-Associated Protein 1 (BAP1) germline mutations predispose individuals to cancers, including uveal melanoma (UM) and cutaneous melanoma (CM). BAP1 loss is common in UM and is associated with a worse prognosis. BAP1 loss is rare in CM and the outcome is unclear. Methods: UM and CM data was retrieved from The Cancer Genome Atlas (TCGA) database. Cox regression model was performed to examine whether BAP1 mRNA levels or copy number variations were associated with overall survival (OS). Results: BAP1-low mRNA predicted a poor OS in UM (HR = 9.57, 95% CI: 2.82, 32.5) but a contrasting better OS in CM (HR = 0.73, 95% CI: 0.56, 0.95). These results remained unchanged after adjusting for sex, age, and stage in UM and CM, or after adjusting for ulceration or Breslow depth in CM. Additionally, low BAP1 mRNA predicted a better OS in CM patients older than 50 years but not in younger patients. Co-expression and enrichment analysis revealed differential genes and mutations that were correlated with BAP1 expression levels in UM and CM tumors. Conclusions: Low BAP1 mRNA was significantly associated with a better OS in CM patients, in sharp contrast to UM. High BAP1 expression in CM was significantly associated with over-expressed CDK1, BCL2, and KIT at the protein level which may explain the poor OS in this sub-group of patients. Function of BAP1 was largely different in CM and UM despite of a small subset of shared co-expressed genes.

Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis

Head & Neck ◽  
2018 ◽  
Vol 40 (6) ◽  
pp. 1174-1184 ◽  
Author(s):  
Diana N. Kirke ◽  
Muhammad M. Qureshi ◽  
Sophia C. Kamran ◽  
Waleed Ezzat ◽  
Scharukh Jalisi ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Stage Iv ◽  
Adjuvant Chemoradiotherapy ◽  
National Cancer Database ◽  
Database Analysis
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