Khaddour Karam, Johanns Tanner M, Ansstas George
Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
Melanoma Manag. 2021 Feb 15;8(2):MMT55. doi: 10.2217/mmt-2020-0022.
The introduction of immune checkpoint blockade (ICB) and BRAF-MEK inhibitors has substantially improved outcomes in patients with metastatic melanoma. However, several challenging factors may hinder the efficacy of ICB in patients with symptomatic intracranial metastatic melanoma who are immunosuppressed due to the use of steroids prior to the administration of ICB. This has resulted in the exclusion of patients treated with high dose steroid at baseline from the majority of ICB clinical trials. In addition, despite the high efficacy of BRAF-MEK inhibitors in -mutant intracranial metastatic melanoma, most tumors will eventually progress. This demonstrates a gap in addressing the best management in such patients. Here, we present a case demonstrating our approach in this patient population.
免疫检查点阻断（ICB）和BRAF-MEK抑制剂的引入显著改善了转移性黑色素瘤患者的治疗效果。然而，在有症状的颅内转移性黑色素瘤患者中，由于在ICB给药前使用了类固醇而导致免疫抑制，几个具有挑战性的因素可能会阻碍ICB的疗效。这导致大多数ICB临床试验将基线时接受高剂量类固醇治疗的患者排除在外。此外，尽管BRAF-MEK抑制剂在BRAF突变的颅内转移性黑色素瘤中疗效显著，但大多数肿瘤最终仍会进展。这表明在处理这类患者的最佳治疗方案方面存在差距。在此，我们展示一个病例，说明我们针对这类患者群体的治疗方法。
