The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma

Derks, Sophie H A E; Joode, Karlijn de; Mulder, Evalyn E A P; Ho, Li Shen; Joosse, Arjen; Jonge, Maja J.A. de; Verhoef, Cornelis; Grünhagen, D.J.; Smits, Marion; Bent, Martin J. van den; Veldt, Astrid A.M. van der

doi:10.1016/j.esmoop.2022.100600

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…MRI remains the preferred method for detecting brain lesions [ 22 ]. Although MRI is not considered effective among patients with completely resected stage III melanoma prior to administering adjuvant treatment [ 52 ], an awareness of the risk factors aids in early detection. Currently, MBM is reported to favor left-side tumors with a significantly higher risk in males than females [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

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

Diaz

Mark

Rodriguez

et al. 2023

Life

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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.

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Section: Discussionmentioning

confidence: 99%

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

Diaz

Mark

Rodriguez

et al. 2023

Life

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“… 48 Additionally, adjusting guidelines to encompass formal categorization of high-risk molecular groups may reduce missed BM due to premature screening in groups with a later time to development of BM. 89 , 90 …”

Section: Discussionmentioning

confidence: 99%

“…Although there are few clinical trials investigating the role of early MRI screening, some studies suggest there is a benefit to identifying BM in asymptomatic patients as they are likely to have fewer and smaller BM. 89 , 95 Maurer et al show that among HER2+ breast cancer patients detected to have BM, the 40% who presented asymptomatically demonstrated better survival (HR 0.49, 95% CI 0.25 to 0.94). 96 Similarly, Laakmann et al show longer median OS in asymptomatic HER2+ breast cancer patients (10.4 vs. 6.9 months).…”

Section: Discussionmentioning

confidence: 99%

Brain metastasis screening in the molecular age

Tabor

Onoichenco

Narayan

et al. 2023

Neuro-Oncology Advances

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The incidence of brain metastases (BM) amongst cancer patients has been increasing due to improvements in therapeutic options and an increase in overall survival. Molecular characterization of tumors has provided insights into the biology and oncogenic drivers of BM and molecular subtype-based screening. Though there are currently some screening and surveillance guidelines for BM, they remain limited. In this comprehensive review, we review and present epidemiological data on BM, their molecular characterization, and current screening guidelines. The molecular subtypes with the highest BM incidence are EGFR-mutated NSCLC, BRCA1, TN, and HER2+ breast cancers, and BRAF-mutated melanoma. Furthermore, BMs are more likely to present asymptomatically at diagnosis in oncogene-addicted NSCLC and BRAF-mutated melanoma. European screening standards recommend more frequent screening for oncogene-addicted NSCLC patients, and clinical trials are investigating screening for BM in HR+, HER2+, and TN breast cancers. However, more work is needed to determine optimal screening guidelines for other primary cancer molecular subtypes. With the advent of personalized medicine, molecular characterization of tumors has revolutionized the landscape of cancer treatment and prognostication. Incorporating molecular characterization into BM screening guidelines may allow physicians to better identify patients at high risk for BM development and improve patient outcomes.

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“…In asymptomatic patients with melanoma stage IIIC and higher, CT or MRI of the CNS should be considered [7]. The results of the analysis of 202 patients done by Derks et al indicate that routine MRI in patients after radical resection of stage III melanoma before starting adjuvant treatment is not recommended [3,16]. Performing periodic MRI examinations for up to 3 years after treatment cessation is indicated to detect asymptomatic CNS metastases (especially in high-risk patients -i.e.…”

Section: Diagnosticsmentioning

confidence: 99%

“…The risk of metastases in the CNS increases with the disease stage [2]. Central nervous system metastases occur in 37% of patients with stage IV melanoma [3]. Currently, there are no known factors identified that predict the risk of CNS metastases in melanoma patients.…”

Section: Introductionmentioning

confidence: 99%

Management of melanoma central nervous system metastases

Rutkowski,

Kiprian,

Świtaj

et al. 2024

Oncol Clin Pract

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The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma

Cited by 7 publications

References 25 publications

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

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

Brain metastasis screening in the molecular age

Management of melanoma central nervous system metastases

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