title: [Melanoma brain metastases : Treatment options].
abstract: The majority of patients with metastatic melanoma will develop brain metastases, which are the most common cause of death. Until recently, local therapies (e. g., neurosurgery, radiotherapy) were the only options for brain metastases; however, effective systemic treatment options are now available. Upon suspicion of brain metastases, diagnostic staging with brain MRI and a neurological investigation are indicated. Prognostic factors such as number of cerebral metastases and symptoms, serum lactate dehydrogenase and S‑100 levels, extracerebral metastases, and ECOG status are considered during therapeutic planning. Treatment planning and therapeutic interventions should be based on an interdisciplinary and multimodal approach. Established treatments for singular brain metastases are neurosurgical resection and stereotactic radiotherapy, which can prolong survival. In patients with asymptomatic BRAF V600E-mutant brain metastases, the BRAF inhibitors dabrafenib, vemurafenib, and immunotherapy with ipilimumab are used. In the case of multiple symptomatic brain metastases, palliative whole-brain radiotherapy is used for treatment, although it has failed to show an overall survival benefit. Increased intracranial pressure and epileptic seizures are addressed with corticosteroids and anticonvulsants. Current clinical studies for melanoma patients with brain metastases are investigating new treatment options such as PD-1 antibodies, combined ipilimumab and nivolumab, combined BRAF inhibitors and MEK inhibitors, and stereotactic radiation in combination with immunotherapy or targeted therapy.
authors.affiliation: Hauttumorzentrum am Universitäts Krebs-Centrum Dresden (UCC), Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Rauschenberg
authors.affiliation: Interdisziplinäre Sektion Neuroonkologie, Zentrum für Neurologie und Klinik für Neurochirurgie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.|Zentrum für Neuroonkologie, Südwestdeutsches Tumorzentrum Tübingen Stuttgart, Universitätsklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.|Zentrum für Personalisierte Medizin, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.|DKFZ Partnerstandort Tübingen, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Tübingen, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Tabatabai
authors.affiliation: Department of Radiation Oncology, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.|OncoRay - National Center for Radiation Research in Oncology, Dresden, Deutschland.|Dresden and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Deutschland.|Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Deutschland.|National Center for Tumor Diseases (NCT), partner site Dresden, Dresden, Deutschland.
authors.forename: E G C
authors.initials: EG
authors.lastname: Troost
authors.affiliation: Hauttumorzentrum am Universitäts Krebs-Centrum Dresden (UCC), Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Garzarolli
authors.affiliation: Hauttumorzentrum am Universitäts Krebs-Centrum Dresden (UCC), Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Beissert
authors.affiliation: Hauttumorzentrum am Universitäts Krebs-Centrum Dresden (UCC), Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland. Friedegund.Meier@uniklinikum-dresden.de.
authors.forename: F
authors.initials: F
authors.lastname: Meier
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D016371:Cranial Irradiation / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D058990:Molecular Targeted Therapy / Q000379:methods; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: BRAF inhibitors; Immunotherapy; Radiotherapy; Surgery; Systemic therapy