Venur Vyshak Alva, Funchain Pauline, Kotecha Rupesh, Chao Samuel T, Ahluwalia Manmeet S
Oncology (Williston Park). 2017 Sep 15;31(9):659-67.
Until recently, therapeutic strategies for melanoma brain metastases focused on local treatments: surgery, whole-brain radiation therapy, and stereotactic radiosurgery. Historically, systemic therapy had limited utility. Immunotherapeutic drugs, such as anti-cytotoxic T-lymphocyte-associated antigen 4 and anti-programmed death 1 agents, and agents targeting the BRAF-MEK pathway have revolutionized the systemic treatment of melanoma brain metastases. Recent clinical trials of these agents have shown activity against melanoma brain metastases, and they are increasingly being used in clinical practice. In this article, we provide an overview of the currently available systemic agents, including immunotherapeutic agents and targeted tyrosine kinase inhibitors. We also provide a practical management algorithm to guide the practicing oncologist in the use of both of these new therapies and the more traditional local treatments.
直到最近，黑色素瘤脑转移的治疗策略主要集中在局部治疗：手术、全脑放射治疗和立体定向放射外科手术。从历史上看，全身治疗的效用有限。免疫治疗药物，如抗细胞毒性T淋巴细胞相关抗原4和抗程序性死亡1药物，以及靶向BRAF-MEK通路的药物，彻底改变了黑色素瘤脑转移的全身治疗。这些药物最近的临床试验显示出对黑色素瘤脑转移的活性，并且它们在临床实践中的使用越来越多。在本文中，我们概述了目前可用的全身药物，包括免疫治疗药物和靶向酪氨酸激酶抑制剂。我们还提供了一种实用的管理算法，以指导执业肿瘤学家使用这两种新疗法以及更传统的局部治疗方法。
