New Era in the Management of Melanoma Brain Metastases

Cutaneous melanoma is an aggressive skin malignancy with an increasing incidence worldwide.1,2 In the United States alone, an estimated 1.1 million people were living with melanoma of the skin in 2014.3 Although melanoma brain metastases (MBM) are the third-most-common origin of metastases to the brain after lung and breast cancers, melanomas exhibit the highest level of cerebral tropism of all cancer types; 40% to 50% of patients with stage IV disease develop brain metastases.4,5 Historically, patients with MBM had uniformly dismal outcomes, especially fatal complications of a disease for which the median overall survival was 7 to 9 months. The remarkable advances in the systemic therapy of melanoma have extended the 1-year overall survival rate of metastatic melanoma from 25% historically to almost 85% now. Systemic treatment in the form of BRAF-targeted therapy and immunotherapy is slowly but surely proving its efficacy in the treatment of MBM and leading to median overall survival times of 14 to 23 months.6,7 Although the local treatment approaches with radiation and surgery remain important and are critically needed in the management of MBM, systemic therapy offers a new dimension that can augment the impact of those therapies and come at a potentially lower cost of neurocognitive impairment. Here, we discuss the underlying biology of MBM, the clinical outcomes from recent clinical trials of targeted and immunotherapy, and the impact of trial outcomes on clinical practice in the context of existing local therapeutic modalities. THE BIOLOGY OF BRAIN METASTASES Section: ChooseTop of pageAbstractTHE BIOLOGY OF BRAIN META... <