ABSTRACT
PURPOSE: Melanoma brain metastases (BMs) are associated with poor survival. Combination immune checkpoint inhibitors (ICIs) with anti-PD1 and anti-CTLA-4 are the international standard-of-care treatment. Most landmark clinical trials excluded real-world patients with symptomatic disease, poor performance status (PS), and steroid use. Despite the high incidence of melanoma in New Zealand (NZ), the only publicly funded systemic treatment is anti-PD1 monotherapy. The real-world outcomes for BMs after ICIs in NZ are unknown. METHODOLOGY: Medical records of patients with melanoma BMs in seven cancer centers across NZ between September 1, 2016, and September 1, 2020, were evaluated. Clinicopathologic characteristics, treatment, intracranial (IC) tumor response rates, IC progression-free survival, and overall survival (OS) are reported. RESULTS: One hundred and forty-four patients received at least one dose of ICI. One hundred and thirty-three (93%) patients received anti-PD1 monotherapy. Almost a quarter of patients had poor baseline PS, 56% were symptomatic, and 33% had corticosteroids. Patients also received local therapies: 61 (42%) patients underwent surgery, 42 (29%) received whole brain radiation, and 47 (33%) received stereotactic radiation. The median OS was 15 months, and a third of patients were alive at 2 years. The toxicity of ICIs was at 28% and 15% for Common Terminology Criteria for Adverse Events grade 1-2 and 3-4 events, respectively. Of the patients who are still alive, 76% of patients remained symptomatic neurologically at last follow-up. CONCLUSION: Most patients in this NZ real-world study were symptomatic and received anti-PD1 monotherapy. Approximately one-third of treated patients are alive at 2 years, but most patients remained symptomatic. This highlights the need for more effective treatment and prospective management of their neurologic rehabilitation needs.
ABSTRACT
OBJECTIVES: Early case report studies and anecdotes from patients, medical colleagues, and social media suggest that patients may present to chronic pain clinics with a number of complaints post COVID-19 infection or vaccination. The aim of this study is to systematically report on a consecutive series of chronic pain patients seen in a community-based pain clinic, who acquired symptoms after COVID-19 infection or vaccination. METHODS: This retrospective cross-sectional descriptive study identified all patients seen at the clinic over a 4-month period (January-April 2022) with persistent symptoms after COVID-19 infection, vaccination, or both. Information was collected on sex, gender, age, details of vaccination, new pains, or exacerbation of old pain plus the development of novel symptoms. RESULTS: The study identified 21 community dwellers (17 females and 4 males; F/M 4.25/1; age range 22-79 years; mean age 46.3 years), with symptoms attributed to COVID-19 infection or vaccination. Several patients suffered exacerbation of previous pains or developed novel pains, as well as high levels of anxiety and mood disorders. A review of the existing literature provides support for the spectrum of symptoms displayed by the study group. CONCLUSIONS: Information collected in this study will add to the body of COVID-19-related literature and assist particularly community practitioners in recognizing and managing these conditions.
