Brain Metastases in Melanoma Require Multidisciplinary Approach

Brain metastases are responsible for the majority of mortality and morbidity among patients with melanoma, and a multidisciplinary approach is necessary to effectively manage this complication, according to a presenter at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.

“ ‘This subject has not been well studied. This is the question that people didn’t want to address, but now people are taking on this task,’ Geoffrey T. Gibney, MD, a medical oncologist in the department of cutaneous oncology at Moffitt Cancer Center, said during a presentation.”

Editor’s note: This article is a good summary of brain metastasis in melanoma.

Combo Chemotherapy Bests Single Drug Against Melanoma

Two chemotherapy drugs may be better than one against melanoma, according to results from an ongoing clinical trial that were presented at the 2013 meeting of the  International Society for Melanoma Research. The drugs were dacarbazine, which is U.S. Food and Drug Administration (FDA)-approved for melanoma, and paclitaxel, which is FDA-approved for breast, lung, and pancreatic cancers. In a phase III trial of 529 melanoma patients, the drug combination kept tumors from growing two times longer than dacarbazine alone (4.8 vs 2.5 months, respectively). The subgroups that did best included men and people with melanomas that had spread to the liver or brain. This is particularly encouraging for the latter group because they have the worst prognosis.

Combination of BRAF Inhibitors and Brain Radiotherapy in Patients With Metastatic Melanoma Shows Minimal Acute Toxicity

“TO THE EDITOR: Recently, Satzger et al reported increased skin toxicity within the irradiated field of patients with melanoma concomitantly receiving BRAF inhibitors and radiotherapy for extracranial metastases. Our data indicate that toxicity on the skin or brain is not a limiting factor for combining BRAF inhibitor treatment and irradiation of brain metastases.”

Checkpoint Modulation in Melanoma: An Update on Ipilimumab and Future Directions

“Ipilimumab, an anti-cytotoxic T-lymphocyte antigen 4 antibody, was the first therapy demonstrated to improve overall survival in melanoma. Since ipilimumab’s approval by the FDA in 2011, a wealth of data has amassed, helping clinicians to optimize its use. We have learned how to mitigate the adverse effects of ipilimumab, identified its effects in melanoma subpopulations such as those with brain metastases, uveal melanoma, and mucosal melanoma, discovered potential biomarkers of activity, and investigated its use in combination with other therapeutic modalities. These discoveries have paved the way for rapid development of second-generation immunomodulatory antibodies such as inhibitors of the programmed cell death 1 receptor axis. These new agents hold promise as monotherapy, but perhaps the greatest allure lies in the possibility of combining these agents in synergistic multidrug regimens.”

Approved Immunotherapy Extends Life After Melanomas Have Spread to the Brain

An FDA-approved immunotherapy was thought to be too risky for people with melanomas that have spread to the brain—but a new study suggests otherwise. The therapy is high doses of interleukin-2, an immune system booster that can have nasty side effects, including seizures and abnormal heart rhythms. In a review of eight melanoma patients with tumors in their brains, this treatment doubled the average survival from 4 months to more than 8 months. The researchers call for extending use of this immunotherapy to melanoma patients with brain metastases.

Survival Patterns Following Brain Metastases for Patients with Melanoma in the Targeted Therapy Era

“Survival from metastatic melanoma (MM) has been significantly prolonged with the introduction of molecularly targeted therapy, including BRAF inhibitors (BRAFi) for patients (pts) with the V600E mutation. Here, we present the first data describing patterns of survival after diagnosis of brain metastases (BM) in a large cohort of these pts with long follow-up.”

Advances in Therapy for Melanoma Brain Metastases

Melanoma cells frequently metastasize to the brain, and approximately 50% of patients with metastatic melanoma develop intracranial disease. Historically, central nervous system dissemination has portended a very poor prognosis. Recent advances in systemic therapies for melanoma, supported by improved local therapy control of brain lesions, have resulted in better median survival for these patients. We review current local and systemic approaches for patients with melanoma brain metastases.”

Vemurafenib and radiation therapy in melanoma brain metastases

“Brain metastases in malignant melanoma carries a poor prognosis with minimal response to any therapy. The purpose of this pilot analysis was to find the effectiveness of vemurafenib, an oral BRAF inhibitor, and radiation therapy in V600 mutated melanoma with brain metastases. BRAF mutation status of the melanoma patients was determined by real-time PCR assay…”

Prognostic Factors for Overall Survival After Radiosurgery in Patients with Melanoma with Brain Mets

Brain metastases (BM) cause significant morbidity and mortality in patients with melanoma. This study identified serum LDH as an independent prognostic factor associated with overall survival. If this finding is confirmed in a prospective manner, the serum LDH level should be included in future prognostic algorithms for patients with melanoma and BM who are to receive stereotactic radiosurgery (SRS), according to the researchers.