1. Should you be dealing with brain mets from melanoma, make sure you are seeing a melanoma specialist...not just an oncologist. Things are constantly changing, updating, and improving (thank goodness!!!!). You need someone on the cutting edge of this data.
2. A primary melanoma lesion that is ulcerated is unfortunately a bad prognostic sign for melanoma progression period, as well as for brain mets, as this first report noted.
3. Re: "high peritumoral T-cell infiltrates are associated with prolonged survival"....in plain English....if there are a lot of T-cells around the tumor, they are trying to kill it and you are more likely to live. Now....we just gotta figure out how to make that happen!!!
4. Treatment with ipi, which has about a 20% response rate in melanoma patients' tumors in their body, is showing the same response rate for melanoma brain mets. (Back to those T-cells again!!!)
5. A combination of ipi and stereotactic radiation is looking to be a combo that is more effective than either on their own, with patients having brain mets showing an overall survival of 28.3 months when given both, but only an OS of 6.9 months when treated with SRS alone. Additionally, the next study shows patients treated with ipi but having had no brain mets had about the same survival as patients with brain mets, when treated with both ipi and SRS.
6. BRAF inhibitors. Ok...first you need to be BRAF positive, with the V600E mutation for these to work. (Researchers are working on other treatments for wild types and NRAS.) There are two BRAF inhibitors currently on the market. The first was Vemurafenib, now named Zelboraf. The second is Dabrafenib, now named Tafinlar. A recent study with Vemurafenib showed a 50% CNS (central nervous system) response rate...that means brain. The last study posted shows that for some reason, when patients were started on the BRAF inhibitor (BRAFi) POST brain tumor, their survival was much increased (to 23.2 months) as opposed to patients who developed a brain met when already on it. Clearly, we have much to learn. BRAF inhibitors are known for some pretty sucky side effects and for their limited time of action, as tumors frequently learn to work around them and start to grow again. Yet, there are those among us who have had great success taking them for years. (Go Dick_K and JMMM!!!!!!) [See my post on new ways to use BRAFi on Jan 13, 2013.]
SO....if in need, check with the authors of these papers. Call them or their institution. Or, get your doc to do so. Things are changing rapidly....and it's about time. Don't miss out on any treatment opportunity that may help you.