Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Clin Adv Hematol Oncol. 2022 Oct;20(10):619-627.
Melanoma is the most aggressive skin cancer, with a high incidence of metastatic spread and a predilection for metastases to the brain. It represents the third most common origin of brain metastases after breast and lung cancer. With the advent of targeted therapy and immunotherapy in melanoma, along with improved local therapy options such as stereotactic radiosurgery (SRS), the treatment of melanoma brain metastases (MBM) has led to significant improvements in outcome. In this review, we provide an overview of management options for patients with MBM while highlighting emerging treatment options. Surgery may be considered for patients with symptomatic MBM, whereas SRS is considered standard for patients with 1 to 4 brain lesions. Combination immunotherapy has led to durable intracranial responses and improved long-term outcomes for patients with asymptomatic MBM. The data available to date have shown that patients with MBM can have a durable response and overall response that are similar to those of patients without brain metastases, and additional trials are ongoing. Mounting evidence suggests that patients with MBM should be considered for inclusion in clinical trials, which range from early-phase trials to phase 3 studies, to accelerate much-needed drug development in this population.
黑色素瘤是最具侵袭性的皮肤癌，转移发生率高，且易转移至大脑。它是继乳腺癌和肺癌之后，脑转移的第三大常见来源。随着黑色素瘤靶向治疗和免疫治疗的出现，以及立体定向放射外科（SRS）等局部治疗选择的改善，黑色素瘤脑转移（MBM）的治疗取得了显著的疗效改善。在这篇综述中，我们概述了 MBM 患者的治疗选择，并强调了新出现的治疗选择。对于有症状的 MBM 患者，可考虑手术治疗，而 SRS 则被认为是治疗 1 至 4 个脑病变患者的标准治疗方法。联合免疫治疗导致无症状 MBM 患者颅内持久缓解和改善长期预后。目前已有数据表明，MBM 患者可获得与无脑转移患者相似的持久缓解和总体缓解，并且正在进行更多的试验。越来越多的证据表明，应考虑将 MBM 患者纳入临床试验，范围从早期试验到 3 期研究，以加速该人群急需的药物开发。
