Clinical Scenario

Patients with amelanocytic melanoma who develop symptomatic brain metastases (MBMs) and require corticosteroid support represent a distinct and challenging treatment population. Systemic therapy selection in this setting depends on both the degree of steroid requirement and the tumour's molecular profile.

Specific Population

This protocol addresses two subgroups within the steroid-requiring MBM population: patients on low-dose steroid support, and patients with neurological symptoms requiring higher-dose corticosteroids for whom local therapy is not an option.

Treatment Approach (Partial Overview)

Treatment in this setting is stratified by BRAF mutation status and corticosteroid dose level, with targeted therapy combinations and immunotherapy combinations among the approaches considered.

Full eligibility criteria, regimen details, sequencing, and evidence grades are available via the link below.

References

DOI: 10.1016/j.annonc.2024.11.006

For patients with symptomatic MBMs requiring steroids (<10 mg/day prednisolone or equivalent):
BRAFi+MEKi if BRAF V600-mutated can be offered [III, A; ESCAT I-A].
Nivolumab+ipilimumab (BRAF-mutated or BRAF-WT) can be offered [III, A].
Patients with MBMs and neurological symptoms requiring steroids (>10 mg prednisolone/day or equivalent) for whom local therapy is not an option can be considered for the following:
BRAFi+MEKi (if BRAF V600-mutated) [III, A; ESCAT I-A].
Ipilimumab+nivolumab [III, B].
ChT (if BRAF-WT) [IV, C].

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Treatment of Amelanocytic Melanoma with Symptomatic Brain Metastases Requiring Steroids

References