Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
Eur J Cancer. 2024 Sep;208:114202. doi: 10.1016/j.ejca.2024.114202. Epub 2024 Jul 6.
With improved systemic treatment and prolonged survival even with metastatic disease, diagnosing, treating, and monitoring brain metastases has become a central topic in the care of patients with melanoma. Patients with brain metastases from melanoma are typically excluded from pivotal clinical trials. When allowed, inclusion and exclusion criteria are rather selective and do not reflect the larger population of melanoma patients with brain metastases who frequently present with neurological symptoms and signs and require steroid medications. Moreover, the lack of consensus on reporting symptomatic brain involvement complicates the interpretation and implications of trial results for the overall population of patients with melanoma and brain metastasis. Here, we review the evidence regarding brain metastasis from melanoma and discuss the challenges of longitudinal neurological clinical assessments, including tools to capture cognition and quality of life. Finally, we propose the adoption of standardized tools to interpret neurological deficits in patients with melanoma and brain metastases and to assess the neurological status in the context of clinical trials.
随着转移性疾病的系统治疗改善和生存时间延长，脑转移的诊断、治疗和监测已成为黑色素瘤患者治疗的核心问题。患有脑转移黑色素瘤的患者通常被排除在关键性临床试验之外。在被允许的情况下，纳入和排除标准相当严格，无法反映出更广泛的伴有脑转移的黑色素瘤患者群体，这些患者常出现神经系统症状和体征，并需要类固醇药物治疗。此外，在报告有症状的脑转移方面缺乏共识，这使得对试验结果的解释和对整体黑色素瘤脑转移患者的影响变得复杂。在这里，我们回顾了黑色素瘤脑转移的相关证据，并讨论了进行纵向神经临床评估的挑战，包括用于评估认知和生活质量的工具。最后，我们建议采用标准化工具来解释伴有脑转移的黑色素瘤患者的神经缺陷，并在临床试验中评估其神经状态。
