Radiation necrosis mimicking rapid intracranial progression of melanoma metastasis in two patients treated with vemurafenib

Optimal treatment of metastases to the central nervous system (CNS) in patients with malignant melanoma remains a clinical challenge. In particular, for patients with BRAF-mutant melanoma and CNS metastases, much remains unknown about the safety and efficacy of the novel BRAF-targeted agents when ad...

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Bibliographic Details
Published in:	Melanoma research Vol. 24; no. 2; pp. 172 - 176
Main Authors:	Liebner, David A, Walston, Steven A, Cavaliere, Robert, Powers, Ciaran J, Sauvageau, Eric, Lehman, Norman L, Wayne Slone, Hasel, Xu-Welliver, Meng, Xia, Fen, Kendra, Kari L
Format:	Journal Article
Language:	English
Published:	England 01-04-2014
Subjects:	Adult Central Nervous System - drug effects Central Nervous System - pathology Central Nervous System - radiation effects Diagnosis, Differential Disease Progression Disease-Free Survival Female Humans Indoles - adverse effects Indoles - therapeutic use Male Melanoma - diagnosis Melanoma - drug therapy Melanoma - pathology Melanoma - radiotherapy Mutation Necrosis - diagnosis Radiation Dosage Radiation Injuries - chemically induced Radiation Injuries - etiology Skin Neoplasms - diagnosis Skin Neoplasms - drug therapy Skin Neoplasms - pathology Skin Neoplasms - radiotherapy Sulfonamides - adverse effects Sulfonamides - therapeutic use Vemurafenib Young Adult
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Summary:	Optimal treatment of metastases to the central nervous system (CNS) in patients with malignant melanoma remains a clinical challenge. In particular, for patients with BRAF-mutant melanoma and CNS metastases, much remains unknown about the safety and efficacy of the novel BRAF-targeted agents when administered in close sequence with radiation. We report two cases of rapid development of CNS radiation necrosis in patients with metastatic melanoma treated with the BRAF inhibitor, vemurafenib, closely sequenced with stereotactic radiosurgery or fractionated stereotactic radiation therapy. In the absence of prospective safety data from clinical trials, we advise vigilance in monitoring patients with BRAF-mutant melanoma whose treatment plan includes CNS radiation and vemurafenib and caution when assessing treatment response within the CNS in these patients.
Bibliography:	David A. Liebner and Steven A. Walston contributed equally to the writing of this article.
ISSN:	0960-8931 1473-5636
DOI:	10.1097/CMR.0000000000000044