Large cohort observational study integrates current knowledge on changes in outcome for melanoma brain metastases in tyrosine kinase inhibitor (TKI)-immunotherapy era

There has been a drastic change in the therapeutic strategy for patients with metastatic melanoma over last 7 years. Since 2011, the US Food and Drug Administration (FDA) has approved a number of drugs for advanced disease, including multi-drug combinations. Overall, the 1-year survival rate shifted from 25% to an impressive 75% (1). In large randomized phase III trials (RCTs), targeting mutations in BRAF-MEK-ERK pathway or inhibiting the cytotoxic T lymphocyte antigen-4 (CTLA-4) and the programmed cell death protein 1 (PD-1) have been shown to achieve a high rate of durable response, when used as first, second line and over; this lead to 2-year and 3-year survival rates above 50% and between 40% and 50% respectively (2,3). While waiting for mature overall survival (OS) data of the newest combinations, we have seen a 25% of patients with stage IV melanoma being cured with immunotherapy, a previously unobserved result; however, still more than half of patients are going to die for progressive disease, and we need to continuously explore new strategies and combination in order to maximize the long-term cure rate