Leptomeningeal melanoma – a case series in the era of modern systemic therapy

Abstract

Leptomeningeal metastases (LM) occur more often in patients with melanoma than many other cancers, and historically these patients have an extremely poor prognosis, with survival ranging from 8-10 weeks (Harstad, Hess, & Groves, 2008). Landmark trials of BRAF inhibitors (BRAFi) and anti-PD-1 checkpoint inhibitor immunotherapy have shown high response rates and prolonged survival in patients with melanoma, but have tended to exclude patients with central nervous system metastasis, particularly those with leptomeningeal metastases (Larkin, Hodi, & Wolchok, 2015; G. V. Long et al., 2014; Robert et al., 2015). Subsequent trials in those with parenchymal brain metastases have shown these agents have similar and often concordant responses to extracranial metastasis, but the activity in those with leptomeningeal metastases has not been adequately addressed in any prospective trial (Goldberg et al., 2016; Georgina V. Long et al., 2017; G. V. Long et al., 2012; Tawbi et al., 2017).

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