Difference between revisions of "CNS melanoma"
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<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div> | <div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div> | ||
|} | |} | ||
| + | <big>'''Note: these are CNS-specific regimens, please see the [[Melanoma|main melanoma page]] for other regimens.'''</big> | ||
{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
=Guidelines= | =Guidelines= | ||
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===References=== | ===References=== | ||
# '''BREAK-MB:''' Long GV, Trefzer U, Davies MA, Kefford RF, Ascierto PA, Chapman PB, Puzanov I, Hauschild A, Robert C, Algazi A, Mortier L, Tawbi H, Wilhelm T, Zimmer L, Switzky J, Swann S, Martin AM, Guckert M, Goodman V, Streit M, Kirkwood JM, Schadendorf D. Dabrafenib in patients with Val600Glu or Val600Lys BRAF-mutant melanoma metastatic to the brain (BREAK-MB): a multicentre, open-label, phase 2 trial. Lancet Oncol. 2012 Nov;13(11):1087-95. Epub 2012 Oct 8. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70431-X/fulltext link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/23051966 PubMed] | # '''BREAK-MB:''' Long GV, Trefzer U, Davies MA, Kefford RF, Ascierto PA, Chapman PB, Puzanov I, Hauschild A, Robert C, Algazi A, Mortier L, Tawbi H, Wilhelm T, Zimmer L, Switzky J, Swann S, Martin AM, Guckert M, Goodman V, Streit M, Kirkwood JM, Schadendorf D. Dabrafenib in patients with Val600Glu or Val600Lys BRAF-mutant melanoma metastatic to the brain (BREAK-MB): a multicentre, open-label, phase 2 trial. Lancet Oncol. 2012 Nov;13(11):1087-95. Epub 2012 Oct 8. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70431-X/fulltext link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/23051966 PubMed] | ||
| + | |||
| + | ==Dabrafenib & Trametinib {{#subobject:7d3694|Regimen=1}}== | ||
| + | {| class="wikitable" style="float:right; margin-left: 5px;" | ||
| + | |- | ||
| + | |[[#top|back to top]] | ||
| + | |} | ||
| + | ===Regimen {{#subobject:23212f|Variant=1}}=== | ||
| + | {| class="wikitable" style="color:white; background-color:#404040" | ||
| + | |<small>'''FDA-recommended dose'''</small> | ||
| + | |- | ||
| + | |} | ||
| + | {| class="wikitable" style="width: 100%; text-align:center;" | ||
| + | !Study | ||
| + | ![[Levels_of_Evidence#Evidence|Evidence]] | ||
| + | ![[Levels_of_Evidence#Efficacy|Efficacy]] | ||
| + | |- | ||
| + | |[https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30429-1/fulltext Davies et al. 2017 (COMBI-MB)] | ||
| + | |style="background-color:#91cf61"|Phase II | ||
| + | | style="background-color:#9ebcda" |ORR: 44-59% | ||
| + | |- | ||
| + | |} | ||
| + | ====Chemotherapy==== | ||
| + | *[[Dabrafenib (Tafinlar)]] 150 mg PO BID | ||
| + | *[[Trametinib (Mekinist)]] 2 mg PO once per day | ||
| + | |||
| + | '''Continued until progression''' | ||
| + | |||
| + | ===References=== | ||
| + | # '''COMBI-MB:''' Davies MA, Saiag P, Robert C, Grob JJ, Flaherty KT, Arance A, Chiarion-Sileni V, Thomas L, Lesimple T, Mortier L, Moschos SJ, Hogg D, Márquez-Rodas I, Del Vecchio M, Lebbé C, Meyer N, Zhang Y, Huang Y, Mookerjee B, Long GV. Dabrafenib plus trametinib in patients with BRAF(V600)-mutant melanoma brain metastases (COMBI-MB): a multicentre, multicohort, open-label, phase 2 trial. Lancet Oncol. 2017 Jul;18(7):863-873. Epub 2017 Jun 4. [https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30429-1/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/28592387 PubMed] | ||
==Ipilimumab & Nivolumab {{#subobject:28103f|Regimen=1}}== | ==Ipilimumab & Nivolumab {{#subobject:28103f|Regimen=1}}== | ||
Revision as of 12:48, 7 May 2018
| Section editors | |||
|---|---|---|---|
 |
Seema Nagpal, MD Palo Alto, CA |
 |
Elizabeth Buchbinder, MD Boston, MA |
5 regimens on this page
5 variants on this page
|
Note: these are CNS-specific regimens, please see the main melanoma page for other regimens.
Guidelines
NCCN
All lines of therapy
Dabrafenib monotherapy
| back to top |
Regimen
| FDA-recommended dose |
| Study | Evidence | Efficacy |
|---|---|---|
| Long et al. 2012 (BREAK-MB) | Phase II | ORR: 31-39% |
Chemotherapy
- Dabrafenib (Tafinlar) 150 mg PO BID
Given until progression of disease
References
- BREAK-MB: Long GV, Trefzer U, Davies MA, Kefford RF, Ascierto PA, Chapman PB, Puzanov I, Hauschild A, Robert C, Algazi A, Mortier L, Tawbi H, Wilhelm T, Zimmer L, Switzky J, Swann S, Martin AM, Guckert M, Goodman V, Streit M, Kirkwood JM, Schadendorf D. Dabrafenib in patients with Val600Glu or Val600Lys BRAF-mutant melanoma metastatic to the brain (BREAK-MB): a multicentre, open-label, phase 2 trial. Lancet Oncol. 2012 Nov;13(11):1087-95. Epub 2012 Oct 8. link to original article contains verified protocol PubMed
Dabrafenib & Trametinib
| back to top |
Regimen
| FDA-recommended dose |
| Study | Evidence | Efficacy |
|---|---|---|
| Davies et al. 2017 (COMBI-MB) | Phase II | ORR: 44-59% |
Chemotherapy
- Dabrafenib (Tafinlar) 150 mg PO BID
- Trametinib (Mekinist) 2 mg PO once per day
Continued until progression
References
- COMBI-MB: Davies MA, Saiag P, Robert C, Grob JJ, Flaherty KT, Arance A, Chiarion-Sileni V, Thomas L, Lesimple T, Mortier L, Moschos SJ, Hogg D, Márquez-Rodas I, Del Vecchio M, Lebbé C, Meyer N, Zhang Y, Huang Y, Mookerjee B, Long GV. Dabrafenib plus trametinib in patients with BRAF(V600)-mutant melanoma brain metastases (COMBI-MB): a multicentre, multicohort, open-label, phase 2 trial. Lancet Oncol. 2017 Jul;18(7):863-873. Epub 2017 Jun 4. link to original article contains protocol PubMed
Ipilimumab & Nivolumab
| back to top |
Regimen
| Study | Evidence | Comparator |
|---|---|---|
| Long et al. 2018 (ANZMTG 01.14) | Randomized Phase II | Nivolumab |
Immunotherapy, part 1
- Ipilimumab (Yervoy) 3 mg/kg IV once on day 1
- Nivolumab (Opdivo) 1 mg/kg IV once on day 1
21-day cycle for 4 cycles, followed by:
Immunotherapy, part 2
- Nivolumab (Opdivo) 3 mg/kg IV over 60 minutes once on day 1
14-day cycles
References
- ANZMTG 01.14: Long GV, Atkinson V, Lo S, Sandhu S, Guminski AD, Brown MP, Wilmott JS, Edwards J, Gonzalez M, Scolyer RA, Menzies AM, McArthur GA. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomised phase 2 study. Lancet Oncol. 2018 Mar 27. link to original article contains verified protocol PubMed