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The Treatment of Melanoma Brain Metastases

  • Melanoma (RJ Sullivan, Section Editor)
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Abstract

Melanoma is the malignancy with the highest rate of dissemination to the central nervous system once it metastasizes. Until recently, the prognosis of patients with melanoma brain metastases (MBM) was poor. In recent years, however, the prognosis has improved due to high-resolution imaging that facilitates early detection of small asymptomatic brain metastases and early intervention with local modalities such as stereotactic radiosurgery. More recently, a number of systemic therapies have been approved by the Food and Drug Administration for metastatic melanoma, resulting in improved survival for many MBM patients. Registration trials for these newer therapies excluded patients with untreated brain metastases, and a number of studies specifically tailored to this population of patients have been conducted or are underway. Herein, we review contemporary locoregional and systemic therapies and describe the unique challenges posed by treatment of brain metastases, such as radionecrosis, cerebral edema, and pseudoprogression. Since the number of systemic and combined modality clinical trials has increased, we expect that the treatment landscape for patients with melanoma brain metastasis will change dramatically. In addition to ongoing clinical trials, which show great promise, we conclude that our understanding of intracranial metastasis remains quite limited. In addition to inter-disciplinary, multi-modality studies, bench-side work to better understand the process of cerebrotropism is needed to fuel more drug development and further improve outcomes.

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  1. Yale New-Haven Hospital, 333 Cedar Street, PO Box 208028, New Haven, CT, 06520, USA

    Nour Kibbi

  2. Yale School of Medicine, New Haven, CT, USA

    Harriet Kluger

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Nour Kibbi has received financial support through grants from Merck, Regeneron Pharmaceuticals, Prometheus Laboratories, and Alexion Pharmaceuticals.

Harriet Kluger has received financial support through a grant from Merck Sharpe & Dohme, and has received compensation from Regeneron Pharmaceuticals, Alexion Pharmaceuticals, and Prometheus Laboratories for service as a consultant.

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This article is part of the Topical Collection on Melanoma

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Kibbi, N., Kluger, H. The Treatment of Melanoma Brain Metastases. Curr Oncol Rep 18, 73 (2016). https://doi.org/10.1007/s11912-016-0555-4

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