Abstract
Brain metastases occur in the majority of patients with metastatic melanoma and are the most common cause of death. Until recently, local therapy (neurosurgery, radiosurgery and whole brain radiotherapy) was the only option for a chance of disease control in the brain. Systemic treatment options are now available. The aim of this study is to discuss the treatment options for brain metastases from ...
Abstract
Brain metastases occur in the majority of patients with metastatic melanoma and are the most common cause of death. Until recently, local therapy (neurosurgery, radiosurgery and whole brain radiotherapy) was the only option for a chance of disease control in the brain. Systemic treatment options are now available. The aim of this study is to discuss the treatment options for brain metastases from melanoma. Treatment recommendations are given in consideration of the S3 guidelines on diagnosis, therapy and follow-up of melanoma and recent publications (Pubmed and manual search). In limited brain metastases, neurosurgery and radiosurgery are established treatments that can prolong survival. Immunotherapy with ipilimumab appears to have activity in patients with brain metastases, particularly when metastases are small and asymptomatic (response rate 16 % and median overall survival 7 months). The BRAF inhibitor dabrafenib achieved response rates of 30-40 % and a median overall survival of 7-8 months in patients with asymptomatic BRAF mutation brain metastases. The intracranial disease control rate was 80-90 %. In patients with symptomatic BRAF mutation brain metastases, the BRAF inhibitor vemurafenib showed activity with a disease control rate of > 80 % and a median overall survival of 5 months. In symptomatic multiple brain metastases, palliative whole brain radiotherapy is an established treatment even though it has failed to show an overall survival benefit. Corticosteroids and antiepileptic drugs are indicated for patients presenting with intracranial hypertension and epileptic seizures. Treatment of patients with metastatic melanoma and brain metastases should be discussed in a multidisciplinary team. The therapeutic options for patients with brain metastases from melanoma have improved in recent years. Presently, there are several effective local and systemic treatments available.
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