The effectiveness of an integrated approach to the treatment of patients with melanoma with metastatic brain lessions (clinical observation)

Background. In Russia, as in the world as a whole, morbidity and mortality associated with skin melanoma are increasing annually. The presence of melanoma brain metastases (MBMs) is traditionally associated with a extremely unfavorable prognosis. Currently, various treatment options for metastatic melanoma are available, including targeted therapy (TT) with BRAF and MEK inhibitors. New approaches have significantly improved the results of treatment of metastatic melanoma, including in patients with MBMs. This article presents the experience of St. Petersburg City Clinical Oncology Dispensary in the treatment of patients with metastatic melanoma with activating BRAF mutation, including patients with MBMs. Objective. Analysis of the clinical results of targeted therapy for patients with disseminated melanoma. Evaluation of the effectiveness of this therapy in patients with the presence of MBMs. Methods. Since 2002, 44 patients diagnosed with disseminated melanoma of the skin have been under observation. MBMs were detected in 8 (18.2%) patients, 31 patients received a combination of BRAF and MEK inhibitors (dabrafenib and trametinib, vemurafenib and cobimeinib) in the framework of TT. 11 patients received monotherapy with BRAF inhibitor. Patients with MBMs were subjected to radiation therapy in addition to TT, two of them underwent surgical treatment of metastases. Results. In the entire patient population, progression of the process was recorded in 29 patients out of 44 (66%), among patients with MBMs - in 3 out of 8. The median progression-free survival (PFS) for all patients of all subgroups was 12 months, and the median overall survival S) - 17 months. 23 out of 44 (52.27%) patients are alive. In the group of patients with MBMs, the median PFS and OS were not achieved, and the mean PFS and OS were 16.90±3.19 and 20.31±2.86 months, respectively. Description of the clinical case. A clinical case of a patient with skin melanoma and MBM, whose life expectancy against the background of complex treatment (surgical treatment+stereotactic radiotherapy+TT) is 2.5 years, is presented. Discussion. Despite the emergence of many new opportunities in clinical practice, the treatment of patients with metastatic melanoma and metastases to the central nervous system remains an important problem of modern clinical oncology. It is necessary to develop new combined approaches to therapy aimed at improving the effectiveness of treatment and improving the quality of life of patients. Conclusion. The authors’ clinical experience clearly demonstrates that the use of an integrated approach in combination with TT for treating patients with melanoma and MBMs in real clinical practice allows increasing the PFS and OS of such patients, making it comparable to that in the absence of MBMs.

metastatic melanoma, melanoma brain metastases, BRAF mutation, targeted therapy, BRAF and MEK inhibitors, dabrafenib, trametinib, vemurafenib, cobimetinib