Department of Dermatology, Medical Faculty of Technische Universität Dresden, University Hospital Carl Gustav Carus, University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Skin Cancer Center at the University Cancer Centre Dresden, Dresden, Germany.
Am J Clin Dermatol. 2018 Aug;19(4):529-541. doi: 10.1007/s40257-018-0346-9.
Recent phase II trials have shown that BRAF/MEK inhibitors and immune checkpoint inhibitors are active in patients with melanoma brain metastases (MBM), reporting intracranial disease control rates of 50-75%. Furthermore, retrospective analyses suggest that combining stereotactic radiosurgery with immune checkpoint inhibitors or BRAF/MEK inhibitors prolongs overall survival. These data stress the need for inter- and multidisciplinary cooperation that takes into account the individual prognostic factors in order to establish the best treatment for each patient. Although the management of MBM has dramatically improved, a substantial number of patients still progress and die from brain metastases. Therefore, there is an urgent need for prospective studies in patients with MBM that focus on treatment combinations and sequences, new treatment strategies, and biomarkers of treatment response. Moreover, further research is needed to decipher brain-specific mechanisms of therapy resistance.
最近的 II 期临床试验表明，BRAF/MEK 抑制剂和免疫检查点抑制剂对黑色素瘤脑转移（MBM）患者有效，报告颅内疾病控制率为 50-75%。此外，回顾性分析表明，立体定向放射外科联合免疫检查点抑制剂或 BRAF/MEK 抑制剂可延长总生存期。这些数据强调了需要进行跨学科和多学科合作，考虑到个体预后因素，为每位患者制定最佳治疗方案。尽管 MBM 的治疗已经有了显著的改善，但仍有相当数量的患者病情进展并死于脑转移。因此，迫切需要对 MBM 患者进行前瞻性研究，重点关注治疗组合和顺序、新的治疗策略以及治疗反应的生物标志物。此外，还需要进一步研究以破译治疗耐药的脑特异性机制。
