[Therapeutic strategies and systemic treatment of brain melanoma metastases].
Brain metastases affect 37% of patients suffering from metastatic melanoma, and their prognosis remains poor, with an overall survival lower than six months. At the moment, there is no standard therapeutic strategy for management of melanoma brain metastases. In some cases, having recourse to a systemic treatment is justified, for example, when brain metastases are combined with a progressive peripheral disease, or with unresecable brain lesions. In France, the use of fotemustine, which received the AMM approval, for metastatic melanoma treatment, is one of the treatments recommended in the case of brain metastases as this chemotherapy, that is active on the melanoma passes the blood-brain barrier. Temozolomide also shows some activity in the brain metastases treatment of melanoma that remains modest in monotherapy but seems interesting when it is combined with radiotherapy. The place of new drugs, in particular ipilimumab and vemurafenib, in the strategy of melanoma brain metastases treatment, still has to be defined and may improve the prognosis of these patients and their quality of life. The new targeted therapies, the widespread use of stereotactic radiosurgery and the improvement in neurosurgical operations would need a prospective clinical assessment, all the more so, in most of clinical studies, the presence of metastases is an exclusion criterion.
Centre Jean-Perrin, département d'oncologie, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France.
Xavier
X
Durando
Sandrine
S
Mansard
Amaury
A
Daste
Pierre
P
Gimbergues
Laura
L
Brocard
Nicolas
N
Magné
Emilie
E
Thivat
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000502:physiology; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D007211:Indoles / Q000627:therapeutic use; D000074324:Ipilimumab; D008545:Melanoma / Q000628:therapy*; D009607:Nitrosourea Compounds / Q000627:therapeutic use; D009943:Organophosphorus Compounds / Q000627:therapeutic use; D010166:Palliative Care; D016634:Radiosurgery / Q000379:methods; D011878:Radiotherapy / Q000379:methods; D012878:Skin Neoplasms; D013449:Sulfonamides / Q000627:therapeutic use; D000077204:Temozolomide; D000077484:Vemurafenib
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D007211:Indoles; D000074324:Ipilimumab; D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; D013449:Sulfonamides; D000077484:Vemurafenib; D003606:Dacarbazine; C054368:fotemustine; D000077204:Temozolomide