What options are available when melanoma spreads to the brain?

Melanoma is a type of skin cancer that can spread to other parts of the body. When it spreads to an internal organ, such as the brain, a patient has advanced or metastatic (met-ah-stat-ic) cancer. This is stage IV, the most serious stage.

Research breakthroughs are helping patients with stage IV melanoma to live longer. Breakthroughs in melanoma research now allow doctors to:

  • Find cancer in the brain sooner
  • Use new tools to determine the best treatment for each patient
  • Treat each patient with more effective therapies

One patient who has benefited from these breakthroughs is former U.S. President Jimmy Carter. In 2015, doctors found melanoma in his brain. Months after receiving breakthrough treatment for his cancer, Mr. Carter said his brain scan showed no sign of cancer.

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Cancer cells can grow, break off, and spread.

How can melanoma spread to the brain?

While melanoma normally begins in the skin, cancer cells sometimes grow and break away from the place where the cancer began. The cells that break away often travel to nearby:

  • Blood vessels
  • Lymph nodes

Once in the blood or lymph (fluid that drains into the bloodstream), the melanoma cells often travel to the lungs, liver, spleen, or brain.

What symptoms develop when melanoma spreads to the brain?

Many patients feel the same. They don’t have any symptoms that would indicate the cancer has spread.

If your doctor thinks that you are at risk for melanoma spreading to your brain, you may need an MRI. An MRI can find cancer in the brain before you have symptoms. Not everyone who has melanoma needs to have an MRI.

When melanoma spreads to the brain and symptoms occur, they may include:

  • Headaches
  • Seizures
  • Paralysis on one side of your body
  • Problems with your eyesight

Symptoms tends to occur when the cancer has spread to more than one area of the brain. A large tumor can also cause symptoms.

How is melanoma treated when it spreads to the brain?

Scientists have learned that attacking this cancer with different types of treatment can improve how well each individual treatment works.

According to the Emory Medical Center, doctors used this approach to treat Mr. Carter. His treatment began with surgery. This was followed by radiation therapy and immunotherapy (a type of medication).

Keep all of your follow-up appointments. Research shows that the earlier melanoma is found in the brain, the more effective treatment can be.

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When melanoma spreads to the brain, the treatment plan may include:

Surgery: Doctors may recommend surgery to:

  • Remove the tumor.

  • Reduce the size of a tumor.
    This can make other treatments more effective.

  • Take out some of the tumor so that it can be examined.
    This allows your doctors to choose the medication most likely to help.

  • Relieve symptoms, such as headaches.

While surgery can remove existing tumors, other treatment often follows. This approach helps to kill cancer cells that surgery cannot remove.

Following surgery, you may be treated with radiation, medication, or both.

Radiation therapy: Radiation therapy helps to kill cancer cells that are too small to be seen. It may also be a treatment option when several tumors have formed in the brain or surgery is too risky.

Two types of radiation therapy are used to treat melanoma in the brain:

  • Gamma knife radiosurgery: Also called stereotactic radiation therapy, this treatment delivers intense radiation to only the tumors. Despite the words “knife,” and “surgery,” no incisions (cuts) are made.

  • Whole brain radiation therapy: As the name implies, the entire brain is treated with radiation. Because treating the entire brain increases the risk of side effects, such as memory loss, this is usually only used to relieve severe symptoms, such as headaches.

The type of radiation used depends on many considerations, including the number of tumors and where they appear in the brain.

While radiation can help to remove tumors, it cannot remove every tumor. It also cannot prevent new tumors. For this reason, some patients also receive medication.

Medication: Research breakthroughs have led to newer medications that are helping patients with advanced melanoma live longer. These newer medications include:

  • Immune checkpoint inhibitors: One job of the immune system is to find and attack cancer cells. Sometimes, cancer cells slip by the immune system undetected. These medications help the immune system find cancer cells so that the immune system can stop or slow down the cancer. Medications that work this way include ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda).

  • Gene-targeted therapies: When cancer develops, it changes (or mutates) genes in healthy cells. A huge research breakthrough occurred when scientists discovered that in some types of cancer, such as melanoma, the gene changes are often the same. This discovery has allowed scientists to develop medications that target these gene changes.

    Targeting gene changes can stop the cancer from growing and spreading. Medications that can do this include dabrafenib (Tafinlar), trametinib (Mekinist), and vemurafenib (Zelboraf).

These medications are not perfect. They can cause side effects. Some side effects can be serious. These medications are also very expensive, so some patients may have difficulty getting insurance to cover the cost.

Supportive care: Also called palliative care, supportive care helps patients to feel more comfortable.

Supportive care can:

  • Relieve symptoms of cancer, such as swelling and headaches
  • Treat side effects from cancer treatment
  • Help with the emotional difficulties of having cancer

Patients of all ages and with all types of cancer receive supportive care. A plan for supportive care may include medication, nutrition, relaxation techniques, and talk therapy. Supportive care is often given along with treatment for cancer.

What else should I know about treatment for advanced melanoma?

Thanks to research breakthroughs, more patients diagnosed with advanced melanoma are living longer — some for years.

Because these breakthrough are relatively recent, it’s important to:

  • Work with a team of melanoma specialists.
  • Ask your melanoma specialists if any of the newer treatments are appropriate for you.
  • Realize that no one treatment works for everyone, so you may need to try different treatments or combine treatments.

Researchers continue to study advanced melanoma, and next-generation treatments are now being studied in clinical trials. If you want to know whether you are a match for a trial, you can find out if there are any relevant trials at:

Clinical Trial Finder


Images
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References
Chukwueke U, Batchelor T, et al. “Management of brain metastases in patients with melanoma.” J Oncol Pract. 2016; 12(6):536-42.

Emory Medical Center. “A year in the life: Jimmy Carter shares his cancer experience.” Posted July 11, 2016. Last accessed March 26, 2018.

Podlipnik S, Carrera C, et al. “Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer (AJCC) stage IIB, IIC, and III localized primary melanoma: A prospective cohort study.” J Am Acad Dermatol. 2016; 75(3):516-24.

Nordmann N, Hubbard M, et al. “Effect of gamma knife radiosurgery and programmed cell death 1 receptor antagonists on metastatic melanoma.” Cureus. 2017; 9(12): e1943.