Current Treatment Options in Oncology

, Volume 14, Issue 2, pp 264–279

Metastatic Melanoma to the Brain: Surgery and Radiation Is Still the Standard of Care

  • Sarah Nicholas
  • Dimitrios Mathios
  • Christopher Jackson
  • Michael Lim
Skin Cancer (WH Sharfman, Section Editor)

DOI: 10.1007/s11864-013-0228-6

Cite this article as:
Nicholas, S., Mathios, D., Jackson, C. et al. Curr. Treat. Options in Oncol. (2013) 14: 264. doi:10.1007/s11864-013-0228-6

Opinion statement

Malignant melanoma with brain metastases remains a difficult disease to treat. Patients presenting with disease affecting the central nervous system (CNS) have a poor prognosis. Treatment depends on a number of factors, including the size and number of lesions, performance status, comorbidities, and presenting symptoms. Physicians and patients must weigh risks and benefits of treatments, with the main goal of palliating symptoms and decreasing the risk of neurological death. Opinions throughout the country vary, but first-line treatment for brain metastases is local therapy involving either craniotomy or stereotactic radiosurgery (SRS) using CyberKnife or Gamma Knife, with or without whole brain radiation therapy (WBRT). Clinical trials remain another option for patients, with chemotherapy reserved for patients who have exhausted other options. There has been a recent surge in knowledge regarding the pathophysiology and treatment of metastatic melanoma leading to recent FDA approval in 2011 of new drugs: ipilimumab, a novel immune therapy, and vemurafenib, which blocks the MAP Kinase pathway. These drugs have the potential to treat patients with metastatic melanoma to the brain but are still undergoing clinical investigation. Despite these recent advances, the prognosis is poor, with few patients able to achieve durable and long-lasting response. Treatment for patients with brain metastases continues to lag behind treatment of other diseases, partly due to their exclusion from early clinical trials.

Keywords

Melanoma Brain metastases Immunotherapy Stereotactic radiosurgery Kinase inhibitors Ipilimumab Vemurafenib Ant-PD1 Craniotomy Whole brain radiation therapy 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sarah Nicholas
    • 1
    • 4
  • Dimitrios Mathios
    • 2
    • 4
  • Christopher Jackson
    • 2
    • 4
  • Michael Lim
    • 2
    • 3
  1. 1.School of MedicineUniversity of MarylandBaltimoreUSA
  2. 2.Department of NeurosurgeryThe Johns Hopkins Hospital University School of MedicineBaltimoreUSA
  3. 3.Department of OncologyThe Johns Hopkins Hospital University School of MedicineBaltimoreUSA
  4. 4.BaltimoreUSA

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