Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Am J Clin Dermatol. 2022 Jul;23(4):523-545. doi: 10.1007/s40257-022-00678-z. Epub 2022 May 9.
Brain metastases from melanoma are no longer uniformly associated with dismal outcomes. Impressive tumor tissue-based (craniotomy) translational research has consistently shown that distinct patient subgroups may have a favorable prognosis. This review provides a historical overview of the standard-of-care treatments until the early 2010s. It subsequently summarizes more recent advances in understanding the biology of melanoma brain metastases (MBMs) and treating patients with MBMs, mainly focusing upon prospective clinical trials of BRAF/MEK and PD-1/CTLA-4 inhibitors in patients with previously untreated MBMs. These additional systemic treatments have provided effective complementary treatment approaches and/or alternatives to radiation and craniotomy. The current role of radiation therapy, especially in conjunction with systemic therapies, is also discussed through the lens of various retrospective studies. The combined efficacy of systemic treatments with radiation has improved overall survival over the last 10 years and has sparked considerable research interest regarding optimal dosing and sequencing of radiation treatments with systemic treatments. Finally, the review describes ongoing clinical trials in patients with MBMs.
脑转移瘤已不再与预后不良划等号。基于肿瘤组织的（开颅手术）转化研究表明，不同的患者亚组可能具有较好的预后。本文回顾了 21 世纪 10 年代前脑转移瘤的标准治疗方法，并概述了近期在脑转移瘤生物学和治疗方面的进展，重点介绍了 BRAF/MEK 和 PD-1/CTLA-4 抑制剂在初治脑转移瘤患者中的前瞻性临床试验。这些额外的全身治疗方法为放疗和开颅手术提供了有效的补充治疗方法和/或替代方案。通过回顾性研究，本文还探讨了目前放疗的作用，特别是与全身治疗相结合的作用。过去 10 年来，全身治疗联合放疗改善了患者的总体生存率，这激发了人们对全身治疗与放疗的最佳剂量和序贯治疗的研究兴趣。最后，本文描述了脑转移瘤患者的临床试验。
