From the Guidelines
The survival rate for metastatic melanoma to the brain is generally poor, with a 2-year survival rate of less than 10% without treatment, but with modern treatments, some patients are living significantly longer, with one-year survival rates ranging from 20% to 50%. The introduction of targeted therapies and immunotherapies has improved outcomes for some patients, with key treatments including BRAF inhibitors (like dabrafenib or vemurafenib) combined with MEK inhibitors (like trametinib) for BRAF-mutated melanomas, and immunotherapies such as pembrolizumab or nivolumab 1. Stereotactic radiosurgery is often used for brain metastases. Factors affecting survival include:
- The number and size of brain metastases
- Overall disease burden
- Patient's performance status
- Response to treatment It's essential to note that while some patients respond well to these newer therapies, outcomes can still be highly variable, and early detection and treatment are crucial for improving survival chances 1.
According to the most recent study, the application of targeted therapy and immunotherapy has led to improvements in survival, with a significant percentage of patients achieving durable disease control or cure with immunotherapeutic approaches 1. The optimal systemic management of patients with melanoma and brain metastases is dependent on numerous considerations, including age, comorbidities, performance status, intracranial/extracranial disease burden, trajectory of disease pretreatment, prior treatment, steroid requirements, and the presence of targetable mutations in genes such as BRAF, NRAS, and KIT 1.
In terms of treatment options, stereotactic radiosurgery (SRS) is often used for brain metastases, and the combination of BRAF inhibitors and MEK inhibitors has shown promising results in patients with BRAF-mutated melanomas 1. The choice of treatment depends on various factors, including the number and size of brain metastases, overall disease burden, and patient's performance status.
Overall, while the survival rate for metastatic melanoma to the brain is still generally poor, modern treatments have improved outcomes for some patients, and early detection and treatment are crucial for improving survival chances.
From the Research
Survival Rate for Metastatic Melanoma to the Brain
The survival rate for metastatic melanoma to the brain varies depending on several factors, including the number of brain metastases, extracranial metastases, and the use of local therapy.
- According to a study published in 2015 2, the median overall survival (OS) for patients with malignant melanoma brain metastases was 3.9 months, with a 1-year survival rate of 21.4%.
- A study published in 2021 3 found that patients with BRAF-mutated advanced melanoma who received first-line immunotherapy had a significantly longer brain metastasis-free survival (BMFS) and overall survival (OS) compared to those who received targeted therapy.
- Another study published in 2022 4 reported a median OS of 4.4 months for patients diagnosed with melanoma brain metastases before 2015, and 7.6 months for those diagnosed after 2015.
- A study published in 2017 5 found that the median OS from the date of diagnosis of brain metastases was 4.83 months, and that the melanoma-specific graded prognostic assessment (msGPA) remained a valid prognostic indicator in the era of novel systemic treatments for melanoma.
Prognostic Factors
Several prognostic factors have been identified for patients with metastatic melanoma to the brain, including:
- Number of brain metastases: patients with multiple brain metastases tend to have a poorer prognosis 2, 4.
- Extracranial metastases: patients with additional extracranial metastases tend to have a poorer prognosis 2, 4.
- Use of local therapy: patients who receive local therapy, such as surgical excision or stereotactic radiosurgery, tend to have a better prognosis 2, 4, 5.
- BRAF mutation status: patients with BRAF-positive melanoma who receive targeted treatment tend to have a better prognosis 3, 5.
- Performance status: patients with a better performance status tend to have a better prognosis 5.
Treatment Options
Several treatment options are available for patients with metastatic melanoma to the brain, including:
- Surgical excision: can be effective for patients with a limited number of brain metastases 2, 4.
- Stereotactic radiosurgery: can be effective for patients with a limited number of brain metastases 2, 4, 5.
- Whole-brain radiotherapy: can be effective for patients with multiple brain metastases, but may have significant side effects 2, 4, 5.
- Systemic therapy: can be effective for patients with metastatic melanoma, including those with brain metastases 3, 4, 5.
- Immunotherapy: can be effective for patients with metastatic melanoma, including those with brain metastases 3, 4.