Page 21 - ARNM-2-2

Advances in Radiotherapy &

Nuclear Medicine

PERSPECTIVE ARTICLE
State of the art in melanoma brain metastatic

treatment and evidence of combined high-dose
radiotherapy and immunotherapy approach

1
Silvia Comas Anton * , Gerard Meca Santamaria 1 , Anabel Mañes Garcia 1 ,
and Maria Gabriela Antelo Redondo 2
1 Department of Radiation Oncology, Catalan Institute of Oncology, Badalona, Spain
2 Department of Radiation Oncology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain

Abstract

Finding the perfect strategy to treat melanoma brain metastases (BMs) has become
a real-world challenge. Despite the difference in response and survival from different
primary tumors, multiple guidelines recommend a multidisciplinary approach to
treating BM. Although these guidelines are not specific for melanoma BM, most
subjects included in the studies on which the guidelines are based are patients with
melanoma. One of the strategies for the treatment of melanoma BM that arouses the
most interest is the concurrent use of stereotactic radiosurgery and immunotherapy.
This strategy seems to be feasible and has shown to improve survival and local control
in retrospective series and phase 1 and 2 prospective trials. Here, we present a review of
the current recommendations for addressing melanoma BM and the evidence available
*Corresponding author: about the strategy combining focal radiation and immune checkpoint inhibitors.
Silvia Comas Anton
(scomas@iconcologia.net)
Citation: Comas AS, Meca SG, Keywords: Melanoma brain metastases; Combined therapy; Stereotactic radiosurgery;
Mañes GA, Antelo RMG. State Immune checkpoint inhibitors
of the art in melanoma brain
metastatic treatment and evidence
of combined high-dose radiotherapy
and immunotherapy approach.
Adv Radiother Nucl Med. 1. Introduction
2024;2(2):3499.
doi: 10.36922/arnm.3499 An important aspect of the management of patients with advanced melanoma is the
Received: April 25, 2024 therapeutic approach to brain metastases (BMs). According to the literature, central
nervous system (CNS) involvement occurs in 40 – 60% of melanoma patients at some
Accepted: May 27, 2024
point throughout the disease course. Some practice guidelines even recommend
1,2
Published Online: June 12, 2024 considering radiologic BM screening for stage IV melanoma. Therefore, it is a critical
3
Copyright: © 2024 Author(s). issue both from a clinical and health management perspective.
This is an Open-Access article
distributed under the terms of the Before the advent of immune checkpoint inhibitors (ICIs) and targeted therapies,
Creative Commons Attribution brain lesions pose a radical challenge to the prognosis of these patients, as they rarely lived
License, permitting distribution, beyond 4 – 6 months. These patients have significantly benefited from the more advanced
4
and reproduction in any medium,
provided the original work is forms of therapies, such as ICIs, BRAF gene inhibitors, and MEK kinase inhibitors, as well
properly cited. as technical developments that enable high-precision radiation delivery.
Publisher’s Note: AccScience
Publishing remains neutral with 2. Therapeutic strategies for BM
regard to jurisdictional claims in
published maps and institutional The main goal when treating melanoma BM is to prevent or delay cognitive impairment
affiliations. while maintaining a satisfactory quality of life and enhancing survival in most cases.
3

Volume 2 Issue 2 (2024) 1 doi: 10.36922/arnm.3499