Researchers recently reviewed a number of new systemic therapies-including combination therapies-for treatment of melanoma brain metastases, including kinase inhibitors that have been shown to effectively target BRAF-mutated melanoma cells.
Chemotherapy is a terrific clinical tool and is an essential treatment for many types of cancer. But chemotherapeutic agents have historically performed poorly in melanoma. Thus, until recently, management of melanoma brain metastases have focused on surgery, stereotactic radiosurgery, or whole brain radiotherapy.
A recent article in Chinese Clinical Oncology reviewed a number of new systemic therapies—including combination therapies—for treatment of melanoma brain metastases, including kinase inhibitors that have been shown to effectively target BRAF-mutated melanoma cells.
Research on new methods to treat melanoma is crucial, because melanoma is relatively common, and, for patients who develop melanoma brain metastasis, the median survival is 17 to 22 weeks. The incidence of overt brain metastasis at first presentation is approximately 20%, and approximately 50% of stage IV melanoma patients develop brain metastases during the course of their disease. The study authors note, “Recently, incorporation of such patients into clinical trials assessing newer systemic therapies has provided increased therapeutic options, and raises questions regarding the optimal selection and combinations of treatment modalities for brain metastasis.”
The review examined molecular predictors of brain metastases closely associated with gene mutations in BRAF, neuroblastoma rat sarcoma oncogene (NRAS), and phosphatase and tensin homolog (PTEN). Among the key findings of the review:
Although preliminary trials focused on targeted and immune therapies have shown promise, there is a need for much greater clinical trial evidence of activity, particularly in combinations with each other. “Enrollment into clinical trials is essential to develop evidenced-based practice paradigms for management of this difficult disease, to study mechanisms of intracranial response and resistance to treatment, and to devise better ways of treatment,” the authors note.