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Epidemiology

Session: Poster Session

EPID-03 - Sex Differences in Odds of Brain Metastasis and Outcomes by Brain Metastasis Status After Advanced Melanoma Diagnosis

Friday, November 17, 2023
7:30 PM – 9:30 PM PT
Location: Exhibit Hall A/B
Non-CME
Sex differences in cancer are well-established. However, less is known about sex differences in diagnosis of brain metastasis and outcomes among individuals with advanced melanoma. Using the nationwide Flatiron Health electronic health record-derived deidentified database, we evaluated individuals diagnosed with advanced melanomafrom 1/1/11-07/30/22 who received oncologist-defined rule-based first line of therapy (N = 7,969, 33% female according to EHR, 35% w/ documentation of brain metastases). Odds of documented brain metastasis diagnosis were calculated using multivariable logistic regression adjusted for age, practice type, diagnosis period (pre/post-2017), ECOG performance status, anatomic site of melanoma, group stage, documentation of non-brain metastases prior to first-line of treatment, and BRAF positive status. Real-world overall survival (rwOS) and progression-free survival (rwPFS) starting from first-line initiation were assessed by sex, accounting for brain metastasis diagnosis as a time-varying covariate using the Cox proportional hazards model, with the same adjustments as the logistic model, excluding group stage, also adjusting for race, socioeconomic status, and insurance status. Adjusted analysis revealed males with advanced melanoma were 22% more likely to receive a brain metastasis diagnosis compared to females (aOR: 1.22, 95% CI:1.09, 1.36). Males with brain metastases had worse rwOS (aHR: 1.15, 95% CI:1.04, 1.28) but not rwPFS (aHR: 1.04, 95% CI: 0.95, 1.14) following first-line treatment initiation. Among individuals with advanced melanoma not diagnosed with brain metastases, survival was not different by sex (rwOS aHR: 1.06 [95% CI: 0.97, 1.16], rwPFS aHR: 1.02 [95% CI: 0.94, 1.1]). This study showed that males had greater odds of brain metastasis and, among those with brain metastasis poorer rwOS compared to females, while there were no sex differences in clinical outcomes for those with advanced melanoma without brain metastasis.