Georgina V. Long, BSc, PhD, MBBS, FRACP, discusses the sequence of local therapy in patients with melanoma who have brain metastases.
Georgina V. Long, BSc, PhD, MBBS, FRACP, co-medical director of Melanoma Institute Australia (MIA), chair of Melanoma Medical Oncology and Translational Research at MIA and Royal North Shore Hospital, University of Sydney, discusses the sequence of local therapy in patients with melanoma who have brain metastases.
There is a lot of debate in the field of melanoma regarding the optimal sequence of local therapy for patients with brain metastases, says Long, specifically, whether patients should receive systemic therapy upfront or local therapy followed by systemic therapy. Although patients with brain metastases have a poor prognosis, it is the entire burden of disease that causes mortality as opposed to the intercranial disease alone.
Therefore, investigators have launched a trial which will randomize patients with brain metastases to receive the combination of frontline ipilimumab (Yervoy) and nivolumab (Opdivo) plus stereotactic radiosurgery versus the combination immunotherapy plus local therapy at the time of progression. The results will determine whether local therapy is best used upfront or as salvage therapy, concludes Long.