This protocol addresses patients with melanoma who present with central nervous system involvement in the form of asymptomatic brain metastases — specifically those without neurological symptoms necessitating corticosteroid use.
In this sub-population, systemic first-line treatment can be initiated without delay, and the absence of steroid requirement is a key factor shaping the therapeutic approach.
For melanoma patients with asymptomatic brain metastases, preferred first-line management involves a combination checkpoint immunotherapy strategy. Anti-PD-1–based regimens also form part of the evidence base for this setting. The full decision algorithm — including sequencing, BRAF mutation status considerations, and selection between available options — is detailed in the structured protocol.
DOI: 10.1016/j.annonc.2021.07.016
The combination of ipilimumab and nivolumab should be the preferred first-line treatment option not only in BRAF wild-type, but also in BRAF-mutated asymptomatic patients.
Anti-PD-1 monotherapy or ipilimumab plus nivolumab has been investigated in patients with BM: in patients with asymptomatic BM, current data favour the combination with an overall response rate of ~50%, reasonable response duration and PFS of >50% at 18 months.
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