Fernandes Gil Nuno Castro
Department of Neurological Surgery, Sion Hospital, Switzerland.
Discoveries (Craiova). 2023 Jun 30;11(2):e169. doi: 10.15190/d.2023.8. eCollection 2023 Apr-Jun.
The incidence of tumor metastases in the brain is many times more frequent than primary brain tumors, affecting a very large share of patients suffering from systemic cancer. Advanced malignant melanoma is well known for its ability to invade the brain space and current treatment options, such as surgery and radiation therapy, are not very efficient and cause notable complications and morbidity. The aim of this review is to explore the recent advances and future potential of using immunotherapy in the treatment of melanoma brain metastases. Several FDA approved immunotherapeutic drugs have shown to be able to at least double the overall survival rates in such patients. Clinical trials of varying phases are underway and available results are promising, significantly prolonging survival rates in patients with previously untreated melanoma brain metastases. Nevertheless, not all patients respond to these immunotherapies, facing a high percentage of resistant cases, without yet knowing the mechanisms and causes of resistance behind. Also, at the time of immunotherapy, a small percentage of patients is affected by pseudoprogression, which can be difficult to distinguish from true progression given the similarity of symptoms. Therefore, there is a pressing need for future research about treatment effectiveness in patients with brain metastases from melanoma, including outcomes from the perspective of patients.
肿瘤脑转移的发生率比原发性脑肿瘤高出许多倍，影响着很大一部分患有全身性癌症的患者。晚期恶性黑色素瘤以其侵入脑间隙的能力而闻名，目前的治疗选择，如手术和放射治疗，效率不高，且会引发显著的并发症和发病率。本综述的目的是探讨免疫疗法在治疗黑色素瘤脑转移方面的最新进展和未来潜力。几种获得美国食品药品监督管理局（FDA）批准的免疫治疗药物已显示至少能使这类患者的总生存率提高一倍。不同阶段的临床试验正在进行，现有结果很有前景，显著延长了先前未治疗的黑色素瘤脑转移患者的生存率。然而，并非所有患者都对这些免疫疗法有反应，耐药病例的比例很高，而且尚不清楚背后的耐药机制和原因。此外，在免疫治疗时，一小部分患者会受到假性进展的影响，鉴于症状相似，很难与真正的进展区分开来。因此，迫切需要对黑色素瘤脑转移患者的治疗效果进行未来研究，包括从患者角度的结果。
