Prise en charge des patients atteints de métastases cérébrales de mélanome

Modesto, A.; Chira, C.; Sol, Jean Christophe; Lubrano, V.; Boulinguez, S.; Pagès, Cécile; Sibaud, V.; Gomez‐Roca, Carlos; Moyal, E. Cohen-Jonathan; Meyer, Nicolas

doi:10.1016/j.canrad.2018.05.006

Cited by 6 publications

(7 citation statements)

References 39 publications

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“…In the latest German guidelines, LT (but not WBRT) is recommended for all BM in case of oligometastatic disease [31]. Definitive or adjuvant SRT delivered in single or multiple fractions, depending on the size of the BM, is recommended in the first management step when technically feasible [19,26,32,33]. In the randomised phase II COMET trial, ablative SRT of oligo-metastatic patients, including those with BM derived from various tumours, was associated with improved OS (13 months) [33].…”

Section: Discussionmentioning

confidence: 99%

“…Prognosis is associated with risk factors including ECOG ≥ 1, presence > 3 BM, extracranial tumour load and age >70 years [13,15,16]. Given the small size of the lesions in both BM trials, the impact of local treatment in the era of novel therapies remains unclear [17][18][19]. We conducted a retrospective study to assess potential prognostic factors, especially outcomes according to administration of local (intracranial) treatment (LT) with surgery and/or radiotherapy for BM in melanoma patients receiving ICI or anti-BRAF therapy.…”

Section: Introductionmentioning

confidence: 99%

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Intracranial Treatment in Melanoma Patients with Brain Metastasis Is Associated with Improved Survival in the Era of Immunotherapy and Anti-BRAF Therapy

Dalmasso

Pagès

Chaltiel

et al. 2021

Cancers

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Metastatic melanoma patients are at high risk of brain metastases (BM). Although intracranial control is a prognostic factor for survival, impact of local (intracranial) treatment (LT), surgery and/or radiotherapy (stereotactic or whole brain) in the era of novel therapies remains unknown. We evaluated BM incidence in melanoma patients receiving immune checkpoint inhibitors (ICI) or anti-BRAF therapy and identified prognostic factors for overall survival (OS). Clinical data and treatment patterns were retrospectively collected from all patients treated for newly diagnosed locally advanced or metastatic melanoma between May 2014 and December 2017 with available BRAF mutation status and receiving systemic therapy. Prognostic factors for OS were analyzed with univariable and multivariable survival analyses. BMs occurred in 106 of 250 eligible patients (42.4%), 64 of whom received LT. Median OS in patients with BM was 7.8 months (95% CI [5.4–10.4]). In multivariable analyses, LT was significantly correlated with improved OS (HR 0.21, p < 0.01). Median OS was 17.3 months (95% CI [8.3–22.3]) versus 3.6 months (95% CI [1.4–4.8]) in patients with or without LT. LT correlates with improved OS in melanoma patients with BM in the era of ICI and anti-BRAF therapy. The use of LT should be addressed at diagnosis of BM while introducing systemic treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intracranial Treatment in Melanoma Patients with Brain Metastasis Is Associated with Improved Survival in the Era of Immunotherapy and Anti-BRAF Therapy

Dalmasso

Pagès

Chaltiel

et al. 2021

Cancers

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“…At time of diagnosis, approximately 20% to 40% of patients diagnosed with stage IV melanoma have brain metastases. [42][43][44] In patients with symptomatic brain metastases, the mainstay of treatment is corticosteroids to control both vasogenic edema and associated symptoms. It has previously been well demonstrated in multiple studies that baseline usage of steroids when starting ICI therapies portends worse outcomes and response rates.…”

Section: Frontline Targeted Therapy Versus Immunotherapy For the Mana...mentioning

confidence: 99%

“…An additional patient population in consideration for targeted therapy before immunotherapy comprised those patients with significant intracranial disease. At time of diagnosis, approximately 20% to 40% of patients diagnosed with stage IV melanoma have brain metastases 42–44 . In patients with symptomatic brain metastases, the mainstay of treatment is corticosteroids to control both vasogenic edema and associated symptoms.…”

Section: Frontline Targeted Therapy Versus Immunotherapy For the Mana...mentioning

confidence: 99%

What Is the Timing and Role of Targeted Therapy in Metastatic Melanoma?

Hadfield,

Sullivan

2024

Cancer J

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Melanoma is the most lethal cutaneous malignancy worldwide. The last 15 years have ushered in several regulatory approvals that have dramatically altered the landscape of treatment options for patients with melanoma. Many patients with melanoma harbor activating mutations in the BRAF proto-oncogene, a key component of the mitogen-activated protein kinase (MAPK) intracellular signaling pathway. Therapies targeting BRAF have led to remarkable improvements in both response rates and survival in patients with metastatic disease. In parallel with these developments in MAPK-targeted therapy has been the clinical development of immune checkpoint inhibitors, which also have improved response rates and survival in patients with metastatic disease including randomized trials compared with MAPK-targeted therapy in patients with advanced, BRAF-mutant melanoma. Immune checkpoint inhibitors have become the preferred first-line standard-of-care treatment for patients with newly diagnosed metastatic disease in patients irrespective of BRAF mutational status. Given these developments, it is now less clear how to optimize the use of MAPK-targeted therapy regarding treatment setting and in sequence with immune checkpoint inhibitor.

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“…Melanoma is the fifth most common malignancy [ 92 ] and the third most common cause of BM after lung cancer and breast cancer [ 93 ]. More than 50% of advanced melanoma patients develop brain metastasis during the course of the disease [ 94 , 95 , 96 , 97 ]. Diagnosis of melanoma brain metastasis is associated with poor prognosis and causes severe neurologic morbidity and death within 3 months if left untreated [ 98 ].…”

Section: Extravasation Of Tumor Cells Through the Blood–brain Barrier...mentioning

confidence: 99%

Insights into the Molecular Mechanisms Mediating Extravasation in Brain Metastasis of Breast Cancer, Melanoma, and Lung Cancer

Alsabbagh

Ahmed

Alqudah

et al. 2023

Cancers

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Brain metastasis is an incurable end-stage of systemic cancer associated with poor prognosis, and its incidence is increasing. Brain metastasis occurs through a multi-step cascade where cancer cells spread from the primary tumor site to the brain. The extravasation of tumor cells through the blood–brain barrier (BBB) is a critical step in brain metastasis. During extravasation, circulating cancer cells roll along the brain endothelium (BE), adhere to it, then induce alterations in the endothelial barrier to transmigrate through the BBB and enter the brain. Rolling and adhesion are generally mediated by selectins and adhesion molecules induced by inflammatory mediators, while alterations in the endothelial barrier are mediated by proteolytic enzymes, including matrix metalloproteinase, and the transmigration step mediated by factors, including chemokines. However, the molecular mechanisms mediating extravasation are not yet fully understood. A better understanding of these mechanisms is essential as it may serve as the basis for the development of therapeutic strategies for the prevention or treatment of brain metastases. In this review, we summarize the molecular events that occur during the extravasation of cancer cells through the blood–brain barrier in three types of cancer most likely to develop brain metastasis: breast cancer, melanoma, and lung cancer. Common molecular mechanisms driving extravasation in these different tumors are discussed.

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Prise en charge des patients atteints de métastases cérébrales de mélanome

Cited by 6 publications

References 39 publications

Intracranial Treatment in Melanoma Patients with Brain Metastasis Is Associated with Improved Survival in the Era of Immunotherapy and Anti-BRAF Therapy

Intracranial Treatment in Melanoma Patients with Brain Metastasis Is Associated with Improved Survival in the Era of Immunotherapy and Anti-BRAF Therapy

What Is the Timing and Role of Targeted Therapy in Metastatic Melanoma?

Insights into the Molecular Mechanisms Mediating Extravasation in Brain Metastasis of Breast Cancer, Melanoma, and Lung Cancer

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