Melanoma Brain Metastases: A Systematic Review of Opportunities for Earlier Detection, Diagnosis, and Treatment

Abstract

Introduction: Melanoma continues to represent the most serious skin cancer worldwide. However, few attempts have been made to connect the body of research on advanced melanoma. In the present review, we report on strides made in the diagnosis and treatment of intracranial metastatic melanoma. Methods: Relevant Cochrane reviews and randomized-controlled trials published by November 2022 were systematically retrieved from the Cochrane Library, EMBASE, and PubMed databases (N = 27). Search and screening methods adhered to the 2020 revision of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Results: Although the research surrounding the earlier detection of melanoma brain metastasis is scarce, several studies have highlighted specific markers associated with MBM. Such factors include elevated BRAFV600 mutant ctDNA, high LDH concentration, and high IGF-1R. The approach to treating MBM is moving away from surgery and toward nonsurgical management, namely, a combination of stereotactic radiosurgery (SRS) and immunotherapeutic agents. There is an abundance of emerging research seeking to identify and improve both novel and established treatment options and diagnostic approaches for MBM, however, more research is still needed to maximize the clinical efficacy, especially for new immunotherapeutics. Conclusions: Early detection is optimal for the efficacy of treatment and MBM prognosis. Current treatment utilizes chemotherapies and targeted therapies. Emerging approaches emphasize biomarkers and joint treatments. Further exploration toward preliminary identification, the timing of therapies, and methods to ameliorate adverse treatment effects are needed to advance MBM patient care.

Demographics aspects of brain and spine metastatic melanoma. Retrospective analysis in a single third-level center

“… 21 Although significant advances have been made in current treatments and with the implementation of dual therapies, chemotherapy, immunotherapy, or combinations, survival has been described from 5 to 9 months, very similar to our reported data. 22 According to Thompson et al, their systematic review found a difference of 6 months in survival in patients treated only with surgery versus those treated with radiotherapy alone (10 months versus four months, respectively). 23 Like our findings, the median survival in patients treated with radiotherapy alone was five months, and for patients treated with surgery, it was 13 months for metastatic lesions to the CNS.…”

Immunotherapy Combined with Radiation in Malignant Melanoma without BRAF Mutations Brain Metastases—Favorable Response after Immunotherapy Continued beyond Progression

“…In another study, conducted by Gaudy-Marqueste C. et al, the median overall survival in BRAF wild-type patients treated with immunotherapy after SRS was 12.3 months [38]. Diaz, M.J. et al, in a systematic review carried out in 2023, reveal that the current treatment of brain metastases in malignant melanomas is directed towards the combination of stereotactic radiosurgery (SRS) and immunotherapeutic agents [39].…”

Biological Insights and Radiation–Immuno–Oncology Developments in Primary and Secondary Brain Tumors

“…Some of the specific pathways or receptors with mutations leading to solid tumors include epidermal growth factor receptor EGFR , ALK , KRAS , ROS1 , BRAF , and HER2 , which can be treated by drugs targeting those specific mutations. Many of the targeted drugs are small molecules which can cross the blood–brain barrier and thus are relatively effective in the upfront treatment of BM harboring these mutations [ 5 , 6 , 7 ]. However, in the absence of genetic targetable drivers, RT is typically used, sometimes in conjunction with surgery as the primary treatment.…”