Home Forums Melanoma Diagnosis: Stage IV Blood/brain barrier: what we know

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    Catherine Poole

    The brain is the most complex organ of our bodies. For melanoma patients, it is always stressful to have metasis go there. Yet, many patients successfully go through SRS or gamma knife radiation to erradicate the mets. But what about Braf/mek/Pd1/IPI passing through the barrier to take care of the mets. There is a lot of speculation about that, without adequate proof yet. What we do know according to Keith Flaherty and Richard Joseph, MD from our scientific board is that the membrane (the blood membrane to the brain) is NOT intact when it allows mets to go there in the first place. Therefore, it would seem logical that these therapies can get through as well. But we just don’t know this. According to Dr. Flaherty:


    We don’t know much about the role of the blood brain barrier with regard to metastatic melanoma becoming established in the first place. All we know is about the efficacy of the drugs.


    what we have been told, is that BRAF inhibitors do cross and the rest is yet to be proven indeed


    From experience of patients I know – Dabrafenib/Trametinib affects mets in the brain (though PD1 not).

    Also one oncologist I trust suggested that comparing Dabrafenib and Vemarafenib the latter is better since its molecule has lower dimensions.

    Catherine Poole

    I think my take on this (after head spinning) is that because the barrier is not intact, and disease was able to enter, then therefore the therapies can enter the brain. But there hasn’t been any study showing the actual presence of them there and whether they are effective in the brain. I think we’ve seen the use of IL2 being directly injected into the brain not having therapeutic value. The brain is SOOOO complex. Kudos to those scientists who are studying how it all works. I hope we have more answers soon. What we do know is that the brain and body works together!


    we will know more when the Combi MB trials report hopefully !


    http://meeting.ascopubs.org/cgi/content/short/33/15_suppl/9009” class=”bbcode_url”>http://meeting.ascopubs.org/cgi/content/short/33/15_suppl/9009

    This abstract from the 2015 ASCO meeting indicates that there IS some response to pembrolizumab anti-PD-1 in brain metastasis.

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