Ramanujam Sangeetha, Schadendorf Dirk, Long Georgina V
Melanoma Institute Australia, Sydney, Australia.
University Hospital Essen, Essen, Germany.
Chin Clin Oncol. 2015 Jun;4(2):25. doi: 10.3978/j.issn.2304-3865.2015.06.06.
Melanoma brain metastases are common, difficult to treat, and are associated with a poor prognosis. Historically, due to the poor activity of chemotherapeutic agents in melanoma, the management of brain metastases was centred on local treatments such as surgery, stereotactic radiosurgery (SRS) or whole brain radiotherapy (WBRT) depending on the clinical presentation. New systemic therapies have now evolved; kinase inhibitors targeting BRAF mutated melanoma cells and activating checkpoint inhibitors that activate an immune anti-tumour response, resulting in significantly improved survival and quality of life for patients with metastatic melanoma and these drugs have demonstrated activity in melanoma brain metastases. As the landscape shifts to incorporate these new systemic agents with the available local therapies, further research into using appropriate combinations or sequences of various treatments, especially for active or progressing melanoma brain metastasis, is required. This review will examine the evidence for systemic therapies in patients with active melanoma brain metastasis (untreated or treated and progressed) and highlight active and evolving clinical trials in this challenging field.
黑色素瘤脑转移很常见,难以治疗,且预后较差。从历史上看,由于化疗药物对黑色素瘤的活性较差,脑转移的治疗主要集中在根据临床表现进行的局部治疗,如手术、立体定向放射外科(SRS)或全脑放疗(WBRT)。现在新的全身治疗方法已经出现;靶向BRAF突变黑色素瘤细胞的激酶抑制剂和激活免疫抗肿瘤反应的免疫检查点抑制剂,显著提高了转移性黑色素瘤患者的生存率和生活质量,并且这些药物在黑色素瘤脑转移中也显示出活性。随着治疗格局转向将这些新的全身药物与现有的局部治疗方法相结合,需要进一步研究如何使用各种治疗方法的适当组合或顺序,特别是对于活跃或进展性黑色素瘤脑转移。本综述将研究活跃性黑色素瘤脑转移(未治疗或治疗后进展)患者全身治疗的证据,并强调在这一具有挑战性领域中正在进行和不断发展的临床试验。