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Current Treatment Options in Oncology
Published in: Current Treatment Options in Oncology 12/2023

30-12-2023 | Melanoma

Systemic Therapy for Melanoma Brain and Leptomeningeal Metastases

Authors: Wendy J. Sherman, MD, Edoardo Romiti, Loizos Michaelides, MD, Diogo Moniz-Garcia, MD, Kaisorn L. Chaichana, MD, Alfredo Quiñones-Hinojosa, MD, Alyx B. Porter, MD

Published in: Current Treatment Options in Oncology | Issue 12/2023

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Opinion statement

Melanoma has a high propensity to metastasize to the brain which portends a poorer prognosis. With advanced radiation techniques and targeted therapies, outcomes however are improving. Melanoma brain metastases are best managed in a multi-disciplinary approach, including medical oncologists, neuro-oncologists, radiation oncologists, and neurosurgeons. The sequence of therapies is dependent on the number and size of brain metastases, status of systemic disease control, prior therapies, performance status, and neurological symptoms. The goal of treatment is to minimize neurologic morbidity and prolong both progression free and overall survival while maximizing quality of life. Surgery should be considered for solitary metastases, or large and/or symptomatic metastases with edema. Stereotactic radiosurgery offers a benefit over whole-brain radiation attributed to the relative radioresistance of melanoma and reduction in neurotoxicity. Thus far, data supports a more durable response with systemic therapy using combination immunotherapy of ipilimumab and nivolumab, though targeting the presence of BRAF mutations can also be utilized. BRAF inhibitor therapy is often used after immunotherapy failure, unless a more rapid initial response is needed and then can be done prior to initiating immunotherapy. Further trials are needed, particularly for leptomeningeal metastases which currently require the multi-disciplinary approach to determine best treatment plan.
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Metadata
Title
Systemic Therapy for Melanoma Brain and Leptomeningeal Metastases
Authors
Wendy J. Sherman, MD
Edoardo Romiti
Loizos Michaelides, MD
Diogo Moniz-Garcia, MD
Kaisorn L. Chaichana, MD
Alfredo Quiñones-Hinojosa, MD
Alyx B. Porter, MD
Publication date
30-12-2023
Publisher
Springer US
Published in
Current Treatment Options in Oncology / Issue 12/2023
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI
https://doi.org/10.1007/s11864-023-01155-3

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