Management of melanoma central nervous system metastases

The basic and applicable rule in the management of melanoma metastases in the CNS should be a multidisciplinary approach involving, at least, a neurosurgeon, radiation oncologist and clinical oncologist experienced in the treatment of melanoma patients with CNS metastases. There are no clear risk factors for melanoma brain metastases. The detection of CNS metastases is associated with poor prognosis; they are the cause of death in 20–50% of patients, and symptomatic tumors are the immediate cause of death in about 90% of patients. Historical data indicated a median OS of 5–7 months after the diagnosis of CNS metastasis. Currently, more and more CNS metastases are diagnosed at the asymptomatic stage using routine brain imaging during the follow-up or qualification for systemic treatment. Treatment of melanoma with CNS metastases includes, depending on the clinical situation, local and/or systemic therapy and symptomatic treatment. In local treatment, advanced techniques of stereotactic radiotherapy are the most valuable. During the last 10 years, 11 new drugs have been registered in Europe for the treatment of patients with advanced melanoma. Due to the introduction of modern systemic therapies, median OS is now about 2 years, based on data from clinical trials. Anti-PD1 and anti-CTLA-4 dual therapy (nivolumab with ipilimumab), when available, can be the choice in patients with CNS metastasis up to 3 cm in diameter and with good performance status. BRAF inhibitors and MEKi can be the upfront treatment in patients with BRAF mutation and asymptomatic metastases. © 2024 Via Medica. All rights reserved.