TY - JOUR
T1 - Metastatic melanoma to the brain
T2 - Surgery and radiation is still the standard of care
AU - Nicholas, Sarah
AU - Mathios, Dimitrios
AU - Jackson, Christopher
AU - Lim, Michael
N1 - Funding Information:
This work was supported by a grant from the Doris Duke Charitable Foundation to Johns Hopkins University School of Medicine to fund Clinical Research Fellow Sarah Nicholas.
PY - 2013/6
Y1 - 2013/6
N2 - 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.
AB - 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.
KW - Ant-PD1
KW - Brain metastases
KW - Craniotomy
KW - Immunotherapy
KW - Ipilimumab
KW - Kinase inhibitors
KW - Melanoma
KW - Stereotactic radiosurgery
KW - Vemurafenib
KW - Whole brain radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=84877738475&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84877738475&partnerID=8YFLogxK
U2 - 10.1007/s11864-013-0228-6
DO - 10.1007/s11864-013-0228-6
M3 - Article
C2 - 23504304
AN - SCOPUS:84877738475
SN - 1527-2729
VL - 14
SP - 264
EP - 279
JO - Current treatment options in oncology
JF - Current treatment options in oncology
IS - 2
ER -