Local Therapies for Melanoma Brain Metastasis
The evidence for use of local therapies in treating melanoma brain metastasis is based on large retrospective melanoma specific studies or based on inference from non-melanoma studies. Surgery is useful in managing solitary or limited intracranial disease especially those with symptoms or complications such as mass effect or haemorrhage and there is some evidence of improved survival. Radiosurgery may be used for small asymptomatic non-haemorrhagic lesions, and reported 12 months local control rates ranges from 52% to 75%. The addition of SRS to WBRT or surgery improves local control and distant brain free survival, but does not affect OS. A phase 3 trial of WBRT following local treatment of melanoma brain metastasis is currently underway, testing distant intracranial failure, OS, neurocognitive function and quality of life (NCT01503827). The WBRT is generally reserved for diffuse or leptomeningeal disease and the combination of WBRT and targeted therapy vandetanib (EudraCT Number: 2011-0006661-12, sponsor protocol number: OCTO_022) and ipilimumab (EudraCT Number: 2013-001132-22, sponsor protocol number: GEM-1202) are currently being tested in phase 2 trials. The addition of WBRT to SRS may affect the quality of life through neurocognitive decline and needs careful consideration while managing such patients.