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

Melanoma Res. 2014 Apr;24(2):172-6. doi: 10.1097/CMR.0000000000000044.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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

Substances

  • Indoles
  • Sulfonamides
  • Vemurafenib