Comprehensive Management of Brain Metastases in Patients with Non-Small Cell Lung Cancer: Emerging Therapies

Rafael García, Amalia Sotoca, Arturo Navarro-Martin, Nuria Rodriguez de Dios, Juan Sepúlveda, Begoña Taboada, Ricardo Diez-Valle, Margarita Martín, Sonia Tejada, Maria Cruz Martin-Soberon and Felipe Couñago

Department of Radiation Oncology, Ruber International Hospital, Spain
Department of Radiation Oncology, Duran and Reynals Hospital, Spain
Department of Radiation Oncology, Sea Hospital, Spain
Department of Neurology, Ruber International Hospital, Spain
Department of Radiation Oncology, Santiago Clinic Hospital CHUS (Santiago University Clinical Hospital), Spain
Department of Radiation Oncology, Ramon y Cajal Hospital, Spain
Department of Neurosurgery, Jiménez Díaz Foundation University Hospital, Spain
Department of Medical Oncology, University Hospital October 12, Spain
Department of Radiation Oncology, University Hospital Quirónsalud Madrid, Spain Faculty of Biomedical Sciences and Health, European University, Spain

^*Correspondance to: Rafael García 

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Abstract:

Purpose: The optimal management of BMs remains uncertain due to a lack of high level evidence (as reflected in the lack of consensus in the main clinical guidelines) and the scant data from Randomized Controlled Trials (RCT) in lung cancer patients with BMs, who have been specifically excluded from most trials. The aim of the present article is to review the multidisciplinary management surgery, radiotherapy, and systemic therapy of brain metastases in NSCLC.
Methods: A literature review was made in this study. Neurosurgeons, Medical Oncologists and Radiation Oncologists were involved to carry out a multidisciplinary review in order to offer the most appropriate evidence. At least two specialists per area performed a review using PubMed, Scopus and Cochrane databases.
Results: Three main treatment modalities were identified: Local treatment including surgery, radiotherapy and radiosurgery. The second one, Systemic treatments: chemotherapy, target therapies and immunotherapy and the last modality was the combination of local treatments and the systemic ones.
Conclusion: Surgery and stereotactic radiosurgery are established treatment strategies for patients with NSCLC who develop brain metastases; however the management of 4 brain metastases or more is under investigation. The use of systemic therapy to manage brain metastases in asymptomatic patients is gaining ground, especially in patients with driver mutations. Regarding combination of local treatment and systemic ones, the sequence and the use of concomitant treatment remains unclear. Several trials are trying to answer this question.

Keywords:

Brain metastases; SRS; Radiosurgery; Metastases

Cite the Article:

García R, Sotoca A, Navarro-Martin A, Rodriguez de Dios N, Sepúlveda J, Taboada B, et al. Comprehensive Management of Brain Metastases in Patients with Non-Small Cell Lung Cancer: Emerging Therapies. Clin Oncol. 2022;7:1921..