Dr. Michael Davies (00:05): Hi, this is Dr. Michael Davis. I am the President Elect of the Society of Melanoma Research, and I am chair and professor of the Department of Melanoma Medical Oncology at the University of Texas MD Anderson Cancer Center, and it's my pleasure to introduce our podcast for today. Advances in the treatments and outcomes for melanoma patients with brain metastases. Our guest today is Dr. Hussein Tawbi, who is professor in the Department of Melanoma Medical Oncology here at MD Anderson and co-director of the MD Anderson Brain Metastasis clinic. Dr. Tawbi, thank you so much for joining us today. Dr. Hussein Tawbi (00:42): Thank you so much for having me. I'm really looking forward to our discussion. Dr. Michael Davies (00:46): So just as a starting place, can you talk about why having knowledge about the diagnosis and treatment of CNS metastasis is so important in the care of melanoma patients? Dr. Hussein Tawbi (01:01): That's a very important question, Mike, and I think a critical component of how we take care of patients with metastatic melanoma. As you know, metastatic melanoma is a disease that has the highest propensity of almost any solid tumor to go to the brain, and we know that our patients with metastatic disease on day one, up to 40% of the time, have brain metastases already in place. Over time, we know that at some point, during the course of their disease, they will end up facing the prospect of a brain metastases. We know from autopsy series that up to 80% will have brain metastases at the time of death. It's a very important aspect for the care of patients with metastatic disease, because it can change what we could do for them. We may have to manage their brain metastases differently than the rest of their metastases outside the brain. Dr. Hussein Tawbi (02:04): As we will talk a little bit later, we may actually have different therapeutic modalities that we can include, and again, will dictate the course of their therapy in general. I think one of the very important aspects to bring up is that, in other cancers like lung and breast cancer, where brain metastases do happen, the typical clinical management is to check for brain metastases or perform brain imaging, only when patients experience symptoms, which is not the practice that we recommend in melanoma, because as I just mentioned, those patients have a high incidence of brain metastases and so we highly recommend doing brain MRIs as part of the initial staging, and again, at the time of restaging for assessing the impact of therapy. Dr. Michael Davies (03:00): Thank you so much. That's a great introduction to the topic, and so, as you alluded to, there are really multiple different types of treatments that are used in the management of patients with melanoma that have brain metastases. Can you talk briefly about these different modalities and the rationale for a multimodality evaluation of patients with CNS involvement? Dr. Hussein Tawbi (03:24): Yeah, so actually, as we have modalities to treat extracranial disease, we do have the three pillars of oncology, right? We have surgical interventions, we have radiation therapy and then we have systemic therapy. So in that regard, we do have the option of using those approaches. However, the brain is the most delicate organ that we have. It has a very direct impact on the patient's functioning and overall quality of life, let alone the mortality that can happen because of brain metastases.