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Advances in Diagnosis and Treatment for Leptomeningeal Disease in Melanoma

  • Melanoma (RJ Sullivan, Section Editor)
  • Published:
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Abstract

Purpose of Review

Melanoma has one of the highest incidences of causing leptomeningeal disease (LMD) among solid tumors. LMD patients have very poor prognosis with a dismal survival despite aggressive management. In this article, we review the current approaches in the management of patients with LMD secondary to melanoma, including updates in diagnosis, treatment, up-to-date clinical studies, and future directions.

Recent Findings

Cerebrospinal fluid (CSF) cytology remains the gold standard for diagnosis, and alternatively, MRI based on clinical presentation can be used. Other approaches such as “liquid biopsies” that detect circulating tumor cells and cell-free DNA have the potential to considerably enhance the diagnosis of LMD from melanoma. As for treatment options, several systemic therapies, involving systemic targeted and immunotherapies have evolved that showed to have possible benefit in LMD patients. Intrathecal chemotherapy, cellular therapy, and immunotherapy are currently under evaluation in Phase I/II clinical trials. In addition, new radiation therapy approaches such as proton cranial-spinal irradiation (CSI) are currently under investigation.

Summary

LMD management still remains challenging. Future studies are critical to elucidate the pathophysiology of LMD in order to develop new urgently needed diagnostic tools and therapies. Clinical trials ought to be expanded to include patients with LMD. Future clinical studies should also integrate tissue interrogation, scientifically designed therapies, and aggressive, early intervention in patients with suspected LMD.

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Authors and Affiliations

  1. Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA

    Yolanda Piña & Peter A. Forsyth

  2. Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Sirisha Yadugiri & Isabella C. Glitza Oliva

  3. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Debra N. Yeboa

  4. Department of Neurosurgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Sherise D. Ferguson

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  1. Yolanda Piña
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Correspondence to Isabella C. Glitza Oliva.

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Yolanda Piña declares that she has no conflict of interest. Sirisha Yadugiri declares that she has no conflict of interest. Debra N. Yeboa declares that she has no conflict of interest. Sherise D. Ferguson has received research funding from Codiak BioSciences. Peter A. Forsyth declares that he has no conflict of interest. Isabella C. Glitza Oliva declares that he has no conflict of interest.

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Piña, Y., Yadugiri, S., Yeboa, D.N. et al. Advances in Diagnosis and Treatment for Leptomeningeal Disease in Melanoma. Curr Oncol Rep 24, 43–54 (2022). https://doi.org/10.1007/s11912-021-01162-3

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