DISP-27. Temporal trends, treatment strategies, and survival disparities in melanoma brain metastases: insights from a 12-year real-world cohort

BACKGROUND Melanoma brain metastases (MBM) present a significant clinical challenge, historically associated with poor prognosis. This study aimed to evaluate temporal trends, treatment patterns, and survival outcomes among patients with MBM in the United States. METHODS We conducted a retrospective analysis in the national cancer database data of 671,241 melanoma patients diagnosed between 2010-2021. Of these, 10,414 had brain metastases (BM), and 10,153 patients were included after excluding cases with missing data. Patient demographics, tumor characteristics, treatments, and survival data were analyzed. Kaplan-Meier curves assessed survival, and multivariable logistic regression and Cox proportional hazards models identified independent predictors of survival. RESULTS The incidence of BM among melanoma patients remained relatively stable, with a modest increase from 15 to 18 per 1,000 between 2010-2021. The median overall survival for MBM was 6.57 months (95% CI: 6.34-6.8). Patients receiving systemic therapy combined with stereotactic radiosurgery (Sys+SRS) had the longest survival (median: 20.17 months, 95% CI: 17.81-22.9), compared to Sys alone (11.01 months, 95% CI: 9.72-12.16), whole brain radiation therapy only (3.09 months, 95% CI: 2.86-3.29), or no treatment (2.07 months, 95% CI: 1.91-2.27). Compared to Sys+SRS, hazard ratios (HRs) for mortality were highest for no treatment (HR: 3.53, p<0.001) and WBRT only (HR: 2.94, p<0.001). Other independent predictors of increased mortality included older age (HR: 1.46, p<0.001), uninsured status (HR: 1.38, p<0.001), income range ($46,276-$57,856, HR: 1.21, p<0.001), and presence of comorbidities (HR: 1.32, p<0.001). Female sex was associated with a reduced risk of mortality (HR: 0.90, p<0.001). Patients diagnosed after 2018 had significantly improved survival compared to earlier years. CONCLUSIONS This study demonstrates that Sys+SRS offers the best survival outcomes for patients with MBM. While these treatments may present better prognoses for MBM patients, socio-economic disparities still exist, highlighting the crucial need for equitable access.