Challenges in treatment strategies for symptomatic brain metastases in melanoma 

Sunandana Chandra, MD, MS, Northwestern University, Chicago, IL, discusses characteristics of symptomatic brain metastases, such as intracranial vasogenic edema, typically treated with high-dose steroids. However, the efficacy of immunotherapies decrease with steroid use, as seen in the CheckMate 204 trial (NCT02320058), which included both symptomatic and asymptomatic brain metastases cohorts. Symptomatic patients treated with a combination of ipilimumab and nivolumab showed lower overall survival compared to asymptomatic patients. The COMBI-MB trial (NCT02039947), which focused on patients with melanoma induced by BRAF mutations, treated symptomatic brain metastases with BRAF/MEK inhibitors dabrafenib and trametinib. While effective, the response was generally lower in symptomatic patients. This interview took place during the 2024 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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