Radiation Oncology, Rutgers Cancer Institute of New Jersey.
Neurosurgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick.
Melanoma Res. 2021 Aug 1;31(4):393-396. doi: 10.1097/CMR.0000000000000750.
Metastatic melanoma is often accompanied by the development of brain metastases, at presentation or during the course of therapy. Local therapies such as surgery and radiation have been considered standard treatments for intracranial disease. However, the emergence of systemic therapies has been changing the treatment paradigm for the management of brain metastases. In patients with BRAF-mutated melanoma, combined BRAF and MEK inhibition has been found to elicit significant clinical responses. Patients who develop resistance to MAP kinase (MAPK) targeted therapy can achieve significant responses upon rechallenge. In this case, a 68-year-old woman with metastatic melanoma who had received multiple treatment courses including combination immunotherapy and combination MAPK-targeted therapy presented with a brainstem metastasis and demonstrated a complete response upon initiation of encorafenib and binimetinib, thereby obviating the need for stereotactic radiosurgery.
转移性黑色素瘤常伴有脑转移的发展，可在就诊时或治疗过程中发生。手术和放疗等局部治疗方法被认为是颅内疾病的标准治疗方法。然而，系统治疗的出现正在改变脑转移管理的治疗模式。在 BRAF 突变型黑色素瘤患者中，联合 BRAF 和 MEK 抑制已被发现可引起显著的临床反应。对 MAP 激酶（MAPK）靶向治疗产生耐药的患者在重新治疗时可获得显著反应。在本例中，一名 68 岁的女性转移性黑色素瘤患者，曾接受过多次治疗，包括联合免疫治疗和联合 MAPK 靶向治疗，出现脑干转移，在开始使用恩考芬尼和比尼替尼后完全缓解，从而避免了立体定向放射手术的需要。
