[Therapeutic strategies and systemic treatment of brain melanoma metastases].

Abstract

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.

• Authors: Xavier Durando, Sandrine Mansard, Amaury Daste, Pierre Gimbergues, Laura Brocard, Nicolas Magné, Emilie Thivat
• Journal: Bulletin du cancer (Bull Cancer) Vol. 100 Issue 1 Pg. 23-8 (Jan 01 2013) ISSN: 1769-6917 [Electronic] France
• Vernacular Title: Stratégies thérapeutiques et traitements systémiques des métastases cérébrales du mélanome.
• PMID: 22889847 (Publication Type: Journal Article, Review)

Chemical References

• Antibodies, Monoclonal
• Antineoplastic Agents
• Indoles
• Ipilimumab
• Nitrosourea Compounds
• Organophosphorus Compounds
• Sulfonamides
• Vemurafenib
• Dacarbazine
• fotemustine
• Temozolomide

Topics

• Antibodies, Monoclonal (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Blood-Brain Barrier (physiology)
• Brain Neoplasms (secondary, therapy)
• Combined Modality Therapy (methods)
• Dacarbazine (analogs & derivatives, therapeutic use)
• Humans
• Immunotherapy (methods)
• Indoles (therapeutic use)
• Ipilimumab
• Melanoma (therapy)
• Nitrosourea Compounds (therapeutic use)
• Organophosphorus Compounds (therapeutic use)
• Palliative Care
• Radiosurgery (methods)
• Radiotherapy (methods)
• Skin Neoplasms
• Sulfonamides (therapeutic use)
• Temozolomide
• Vemurafenib