Melanoma brain metastasis (MBM) is found in 30–40% of patients with advanced melanoma. While treatment options are accessible, MBM remains a challenge to treat effectively.
Around 30-40% of patients with advanced melanoma present with melanoma brain metastases (MBM) at diagnosis, with a higher percentage of patients exhibiting MBM at the time of death in autopsy. The risk of complications and death is higher in MBM patients than in other cancer patients. While surgery is typically recommended in patients with MBM, targeted immune therapies have been shown in post-approval studies to have some benefits.
One systematic review was conducted to examine the impact of systemic therapies, such as immune checkpoint inhibitors (ICIs) and BRAF/MEK inhibitors, on patients with MBM. Although patients with MBM were excluded from initial clinical trials of ICIs and BRAF/MEK inhibitors, post-approval studies have suggested that ICIs and BRAF/MEK inhibitors can be effective. Studies were collected from the PubMed, Scopus, and Embase databases and analyzed.
Ipilimumab has been shown to be an effective ICI in studies of untreated MBM. A phase II trial analyzed in the review confirmed the safety and intracranial efficacy of ipilimumab with durable benefit exhibited at follow-up periods. BRAF inhibitors, such as vemurafenib and dabrafenib were also found to have intracranial effects in patients with MBM. Many studies have laid the groundwork for future treatments and the need for effective treatments in patients with leptomeningeal disease (LMD).
The use of ICI and targeted therapies has significantly improved the management of intracranial disease with melanoma. Still, challenges with resistance and reduced treatment response over time remain a concern. Healthcare providers with MBM patients are encouraged to stay up to date on the current and future treatment options to improve outcomes with minimal toxicities.
Source:
Saleem, K., & Davar, D. (2022). The role of systemic therapy in melanoma brain metastases: a narrative review. Chin Clin Oncol, 11(3), 24. https://doi.org/10.21037/cco-22-1
