The Role of Systemic Therapy in Melanoma Brain Metastases

A Narrative Review

Kainat Saleem; Diwakar Davar


Chin Clin Oncol. 2022;11(3):24 

In This Article

Special Circumstances

Leptomeningeal Disease

Melanoma LMD carries a dismal prognosis, with median survival being only a few weeks,[6] and limited data regarding effective treatment options. While RT may be considered for symptomatic areas of the spine,[143] there is a paucity of evidence regarding the role of systemic therapy in LMD. Case reports and series support efficacy of BRAF/MEK inhibitors in BRAF mutated LMD.[144–146] In Cohort C of the ABC trial, 4 out of 16 patients had LMD and were treated with single-agent nivolumab, with no intracranial responses being observed.[88] Intrathecal (IT) interleukin-2 (IL-2) has been used in a small study of LMD patients with models results (median OS 7.8 months, 1-, 2-, and 5-year OS rates of 36%, 26%, and 13%, respectively).[147] The study also showed an improvement in radiological findings on brain imaging in 39% patients, and in 32% patients on spine imaging. The role of combined IT and systemic anti-PD-1 is being evaluated in a phase I/II study in LMD (NCT03025256).