Abstract Brain metastases from melanoma (MBMs) present significant treatment challenges due to their aggressive nature and the complexity of managing both intracranial and extracranial disease. Advances in systemic therapies, including immune checkpoint inhibitors (ICIs) and targeted agents, such as BRAF and MEK inhibitors, have improved outcomes for MBM patients, particularly those with asymptomatic disease. Combination therapies, especially nivolumab plus ipilimumab, have shown higher intracranial response rates and durable control compared to monotherapies. Local treatments, including stereotactic radiosurgery (SRS) and surgical resection, remain vital for managing symptomatic or large lesions and may enhance systemic therapy efficacy when integrated appropriately. Recent evidence suggests synergy between ICIs and radiation, leading to improved tumor control and survival, though risks of radiation necrosis require further study. Despite the decline in whole-brain radiotherapy (WBRT) due to limited survival benefits and cognitive side effects, its role as adjuvant therapy after SRS or surgery continues to be explored. Multidisciplinary approaches tailored to individual patient characteristics are essential to optimize outcomes. Ongoing clinical trials will further clarify the safety and efficacy of combined systemic and local treatment modalities in MBM management.
Slavkov et al. (Mon,) studied this question.