Metastatic tumors to the brain are an increasing cause of morbidity and mortality in patients with systemic cancers. Many
new therapies used to treat systemic cancers do not penetrate the central nervous system (CNS) and do not protect patients
from the development of brain metastases. Surgery, radiosurgery, and radiation therapy are all used to treat brain metastases.
It is in our opinion a mistake to use only one or two of these modalities to the exclusion of other(s). The role of systemic
chemotherapy is still limited, due to both the issues of drug delivery caused by the blood brain barrier and to the relative
resistance of many of these tumors to chemotherapy. Traditionally, brain metastases have been grouped together regardless
of the origin of the tumor and have been treated with a single algorithm. As we encounter more patients for whom treatment
of the brain metastases is an important determinant of survival, we must tailor our treatment strategies to individual tumor
types. Also, we must recognize differences in each tumor’s sensitivity to chemotherapy and radiotherapy and differences in
"Patients with inoperable disease are usually treated with whole-brain radiation therapy (WBRT) or chemotherapy such as temozolomide (Eichler and Loeffler, 2007). Response rates to single-agent chemotherapy are <10%, and treatment simply attempts to slow disease progression (Ewend et al., 2001; Agarwala et al., 2004; Eichler and Loeffler, 2007). It is becoming clearer that the genetic background of a certain patient (i.e., germline mutations) or a tumor should dictate its treatment regimen, and that targeted therapy against these tumor-specific alterations (if available) may be more efficacious. "
[Show abstract][Hide abstract] ABSTRACT: Brain metastasis (B-Met) from melanoma remains mostly incurable and the main cause of death from the disease. Early stage clinical trials and case studies show some promise for targeted therapies in the treatment of melanoma B-Met. However, the progression-free survival for currently available therapies, although significantly improved, is still very short. The development of new potent agents to eradicate melanoma B-Met relies on the elucidation of the molecular mechanisms that allow melanoma cells to reach and colonize the brain. The discovery of such mechanisms depends heavily on pre-clinical models that enable the testing of candidate factors and therapeutic agents in vivo. In this review we summarize the effects of available targeted therapies on melanoma B-Met in the clinic. We provide an overview of existing pre-clinical models to study the disease and discuss specific molecules and mechanisms reported to modulate different aspects of melanoma B-Met and finally, by integrating both clinical and basic data, we summarize both opportunities and challenges currently presented to researchers in the field.
Frontiers in Oncology 05/2013; 3:127. DOI:10.3389/fonc.2013.00127
[Show abstract][Hide abstract] ABSTRACT: Central nervous system (CNS) metastases from ovarian adenocarcinoma are uncommon. The long-term prognosis for these patients is poor, with studies reporting a mean survival of less than 12 months.
We present a case involving a 57-year-old woman diagnosed and treated for primary ovarian cancer in 1994. She underwent optimal cytoreductive surgery and received adjuvant chemotherapy. In 1996, she was diagnosed with a right cerebellar metastatic lesion, and treated with surgery and whole-brain radiotherapy. She is currently 7 years post-treatment of her brain metastasis without evidence of recurrent disease.
Brain metastases from primary ovarian cancer are a relatively rare finding. These patients have a poor prognosis, with studies reporting a mean survival of 12 months. However, the patient in this report remains disease-free since her treatment for metastatic disease. Aggressive surgical and radiation treatment for patients with isolated CNS metastases is reasonable.
[Show abstract][Hide abstract] ABSTRACT: Background: Inoperable melanoma brain metastases are usually uniformly fatal, and complete response after cytotoxic therapy is rare. Case report: A patient with multiple inoperable melanoma brain metastases was treated with 6 cycles of oral temozolomide (300 mg once daily over 5 days every 28 days). A complete response was documented by magnetic resonance. Conclusions: The present observation suggests that temozolomide may be an active and well tolerated treatment for malignant melanoma brain metastases.
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