Dr. Kluger on Systemic Management of Melanoma With Brain Metastases

Harriet Kluger, MD, professor of medicine, associate cancer center director for education and training, deputy section chief, Medical Oncology, Yale Cancer Center, discusses the progression of treatment for patients with melanoma who have brain metastases.

Prior to 2011, though not a standard of any other organ, patients with brain metastases had been excluded from clinical trials with the exception of patients whose metastases had been stabilized for many weeks.

It has since been discovered that other organs with a similar prognosis have a worse prognosis than in the brain. These patients had been excluded due to concerns about side effects in the brain and whether these drugs could penetrate the blood-brain barrier.

A number of trials have since been conducted, mainly with melanoma, but are starting to be used in other diseases as well. Research suggests responses in the brain are similar to those in extra cerebral sites. Though stereotactic surgery has had a high success rate in treating patients with brain metastases, systemic therapy is now becoming an integral part of therapy for patients whose diseases have metastasized to the brain.