Current Treatment of Melanoma Brain Metastasis.
Opinion Statement: With greater understanding of underlying biology and development of effective BRAF-targeted therapy and immunotherapy, along with remarkable advances in local treatment such as stereotactic radiosurgery, melanoma brain metastasis (MBM) is witnessing continually improving outcome,...
| Publicado en: | Current Treatment Options in Oncology Vol. 21; no. 6; pp. 1 - 25 |
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| Autores principales: | , |
| Formato: | research Journal Article |
| Publicado: |
Springer Nature
Jun2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143759531&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 143759531 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15272729 3KHC jtl: Current Treatment Options in Oncology issn: 15272729 maglogo: N pubinfo: dt: Jun2020 vid: 21 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 143759531 143759531 NLM32350685 143759531 10.1007/s11864-020-00733-z NLM32350685 143759531 ppf: 1 ppct: 24 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Current Treatment of Melanoma Brain Metastasis. aug: au: Rishi, Anupam Yu, Hsiang-Hsuan Michael affil: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, 33612, Tampa, FL, USA sug: subj: Brain Neoplasms Therapy Brain Neoplasms Melanoma Pathology Clinical Trials Brain Neoplasms Diagnosis Prognosis Melanoma Therapy Disease Management Melanoma Etiology Risk Factors Brain Neoplasms Mortality Disease Susceptibility Combined Modality Therapy Adverse Effects Treatment Outcomes Combined Modality Therapy Methods Human Scales Ferrans and Powers Quality of Life Index ab: Opinion Statement: With greater understanding of underlying biology and development of effective BRAF-targeted therapy and immunotherapy, along with remarkable advances in local treatment such as stereotactic radiosurgery, melanoma brain metastasis (MBM) is witnessing continually improving outcome, with 1-year overall survival rate approaching 85%. Given disease complexity and myriad treatment options, all patients with MBM should ideally be evaluated in a multidisciplinary setting to allow an individualized treatment approach based on prognostic groups, molecular classification, number and size of brain metastasis, and performance status. With improving outcome, pendulum has now swayed to focus more on effective treatment modalities with minimal neurological toxicity while maintaining quality of life. Surgery is usually considered in symptomatic and large MBMs, while stereotactic radiosurgery considered in 1-4 lesions, and now also being explored for up to 15 brain metastases for improved local control. The role of whole brain radiotherapy is diminishing given its neurocognitive toxicities and is reserved for patients with diffuse brain involvement. Cytotoxic chemotherapy has largely been ineffective without evidence for survival benefit. Immune checkpoint inhibitors have become the cornerstone of management for melanoma brain metastasis with durable intracranial tumor control and excellent toxicity profile. For patients with asymptomatic MBMs, ipilimumab and nivolumab have shown intracranial response near 60% and provides comparable clinical benefit in MBMs as for extracranial metastases. For patients with driver BRAF mutation, BRAFi-/MEKi-targeted agents are proven to be effective in MBM with high rate intracranial responses (44-59%). However, the durability of intracranial responses induced by BRAFi/MEKi seems to be shorter than that of extracranial disease. Emerging data support novel combination of systemic therapy and stereotactic radiosurgery, which appears to be safe and effective; however, potential benefits and risks should be evaluated prospectively. Promising ongoing trials will further expand therapeutic evidence in MBM, and patients should be encouraged to participate in clinical trials. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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