Eric D. Whitman, MD
The Impact of Immuno-Oncology on Melanoma Brain Metastases
New immuno-oncology drugs have drastically improved survival rates for patients with metastatic melanoma. This includes combination immunotherapy drugs that yield a 50 percent response rate for patients with melanoma brain metastases. Eric D. Whitman, MD, medical director of Atlantic Health System’s oncology service line, explains why immuno-oncology treatment is typically the best first course of action.
How often does primary melanoma metastasize systemically – and how often does it metastasize to the brain?
Most melanomas are low risk and do not metastasize. One out of every 10 people with melanoma end up having metastatic melanoma. Of those with metastatic melanoma, about 20 percent go on to develop brain metastases. Interestingly, some melanomas are prone to metastasizing only in the brain.
How has immuno-oncology changed the course of treatment for melanoma and brain metastases associated with melanoma?
Melanoma is one of the most responsive types of cancer to immunotherapy – the newest kind of drugs that stimulate a patient’s own immune system to kill cancerous cells. In fact, melanoma was one of the first cancers to respond consistently to immuno-oncology drugs and one of the first cancers the U.S. Food & Drug Administration approved the drugs for back in 1995. Since then, the drugs have only evolved and improved. Not only are they less toxic, they can now also target specific mutations, such as the common BRAF mutation that’s present in 40 percent of melanomas.
When it comes to patients with melanoma brain metastases, the most effective drug treatment available today is a combination of immuno-oncology drugs – OPDIVO® and YERVOY® – which yields a 50 percent response rate. However, there are also other effective treatment options, including surgery and radiation therapy, which can be given in sequence or even in parallel. With multiple options for treatment, it’s best for patients to be evaluated by a multidisciplinary team of experts that can determine the best course of action for their individual case.
What are the survival rates for people with metastatic melanoma?
We are seeing huge improvements in the prognosis for patients with metastatic melanoma due to these immunotherapies. Currently the average survival rate is 50 percent at five years. Just 10 years ago, it was 50 percent at six months.
Why do melanoma survivors need to monitor neurologic symptoms?
First, they need to remember that melanoma can recur even years after being treated successfully. Even if you feel like you are doing well, it is important to keep that in the back of your mind. Second, anyone with a history of melanoma (or other cancers) needs to be particularly vigilant about monitoring neurologic symptoms as they could indicate the disease has returned and metastasized in the brain. Things to look out for are stroke symptoms such as weakness in an arm or leg, seizures or a severe headache that doesn’t go away. If you have any symptoms or concerns, it is best to contact your oncologist and be proactive in protecting your health.