Sunday, July 19, 2015

A really good review of treatment data for Melanoma Brain Mets!!!

Clinical Management of Multiple Melanoma Brain Metastases:  A Systematic Review
Goyal, Silk, Tian, et al.  JAMA Oncol.  2015 May 21.

Treatment of brain mets from melanoma is controversial and includes surgical resection, SRS, and WBRT.  Several new classes of agents have revolutionized the treatment of metastatic melanoma, allowing some subsets of patients to have long-term survival.  Given this, brain met management in melanoma is continually evolving.  A PubMed database search for related terms...published from Jan 1995 - Jan 2015....was reviewed.  Of 2243 articles initially id'd, 110 were selected for full review.  Of these, 73 were included here.  

Level 1 evidence supports use of SRS alone, WBRT, and SRS with WBRT.  Although the addition of WBRT to SRS improves the overall brain relapse rate, WBRT has no significant impact on overall survival and has detrimental neurocognitive outcomes.  Cytotoxic chemo has largely been ineffective; targeted therapies and immunotherapies have been reported to have high response rates and deserve further attention in larger clinical trials.  Further studies are needed to fully evaluate the efficacy of these novel regimens in combination with radiation therapy. Emerging data exist to support the notion that SRS in combination with targeted therapies or immune therapy may obviate the need for WBRT.

A much better review of data regarding the treatment of melanoma brain mets incorporating the new systemic therapies.  And, YES!!!!  We certainly need studies looking at the results of anti-PD1, ipi, and BRAFi when combined with SRS.  These treatments were withheld from folks with brain mets for far too long!  Hopefully that tide has turned!!!

Sad that all this is taking so long given this data out of ASCO 2013!!!  Brain Mets in melanoma the latest from ASCO 2013

Info from ASCO 2015 re: Pembro/Keytruda and an ongoing brain met study:  ASCO 2015 pembrolizumab/keytruda

Also out of ASCO 2015....ongoing study with Nivo/Opdivo and ipi/Yervoy for brain mets:  ASCO 2015 new nivo/ipi trial for melanoma brain mets

Discussion of brain met patients in clinical trials from 2014:  Should melanoma brain met patients be allowed in clinical trials?

More data that ipi and anti-PD1 work in the brain:  Anti-pd1 and ipi and t cells in the brain

Vemurafenib works in the brain:  Vemurafenib really does work on brain mets!

Thanks, ratties!  - c


  1. Hello Celeste,
    A well deserved thanks to you for all the dedication you show on the MPIP.
    I was one of the first 53 that received ippi/nivolumab at Yale/Sloane.
    Two Cyberknifes to the brain and two open surgeries to the brain. Dr. Chiang could not remove all the cancer, too close to the ventricle. Three years NED. So the combo did wipe out the melanoma in the brain.
    Lost my pituitary, adrenal and thyroid glands. Couple of pills each day, no big deal.
    Keep up the great work.
    We have been blessed.

  2. That is very kind of you to say, John. Sorry for your losses, though I agree....losing melanoma is worth it! Congrats on your 3 years NED! May it last a zillion more! Thanks for being a rattie. They are awesome peeps!