The management of brain metastases in melanoma patients

Among solid tumors, melanoma is the most aggressive form of skin cancer, with the highest risk of developing brain metastasis. The central nervous system is the most frequent initial site of treatment failure, both with chemotherapy and with biological therapies. The combination of antiCTLA4 and antiPD1 is superior to single agents alone in terms of rapidity and duration of responses, although its activity is limited in symptomatic patients. Target therapy induces rapid responses in a significant proportion of patients, but these are generally short-lasting. Currently, there is a great interest in evaluating the combination with new immunotherapy and antiangiogenic agents, with sequential or concomitant radiotherapy. Multidisciplinary management of patients with melanoma brain metastasis is crucial to provide the best treatment in the context of a patient-centered approach.