Melanoma brain metastases - Interdisciplinary management recommendations 2020

Area of Science:

• Neuro-oncology
• Dermatology
• Medical Oncology

Background:

• Melanoma brain metastases (MBM) are common and lead to poor prognosis.
• Historically, treatments like systemic therapy and whole brain radiation offered limited survival benefits.
• Recent advances show promise with immune checkpoint inhibitors and MAP-kinase inhibitors.

Purpose of the Study:

• To review prospective clinical studies in MBM.
• To identify evidence gaps in MBM diagnosis and treatment.
• To provide expert recommendations for MBM patient management.

Main Methods:

• Interdisciplinary expert team review of prospective clinical studies.
• Analysis of outcomes for diagnosis, treatment, and monitoring.
• Development of recommendations for four distinct MBM patient scenarios.

Main Results:

• Combined anti-CTLA-4/PD-1 immunotherapy with stereotactic radiosurgery is recommended for asymptomatic MBM.
• Adjuvant whole-brain radiotherapy offers no benefit in oligometastatic MBM.
• Combined MAPK-kinase inhibition is an alternative for BRAF^V600-mutated MBM patients with symptomatic or rapidly progressing disease.

Conclusions:

• Updated management strategies for MBM are proposed based on prospective data.
• Immunotherapy and stereotactic radiosurgery represent a significant advancement in MBM care.
• Tailored systemic therapies, including MAPK-kinase inhibitors, offer options for specific MBM patient subgroups.