TREATMENT OF BRAIN METASTASES OF MALIGNANT-MELANOMA - VALUE OF FOTEMUSTINE

Since 1988 relatively promising results have been reported with fotemu stine. The purpose of this report is to evaluate the contribution of t his drug to the management of brain metastasis of melanoma among other methods. Whole brain radiotherapy is widely used as the first choice method with high response rate but modest survival time. Surgery has a chieved the longest survival but only a few patients are eligible. Pos toperative radiation therapy seems to improve median survival. Stereot actic radiosurgery allows treatment of brain metastasis without side e ffects of conventional radiotherapy or craniotomy: median survival tim e is comparable to that of surgery with a better quality of life. Chem otherapy for brain metastasis is limited by the blood-brain barrier, a nd the different drugs obtained only marginal responses irregardless o f the schedule. Based on the results of phase II trials using single a gent fotemustine and diverse combination treatments, fotemustine is cu rrently the most-potent drug against brain metastasis of melanoma. Adv erse effects are acceptable:and ambulatory treatments are feasible. Ho wever, mean duration response is short and median overall survival is 3-6 months. Fall in response rate is noted with previous chemotherapy, increasing tumor load and decreasing patient performance status. A mu ltidisciplinary approach based on extent of metastatic disease and pat ient general health is outlined. Guiding the patient with more effecti ve care, without unnecessary toxicity, remains the physician's aim in view of the lack of effective treatment.