Background
Neurological symptom burden in BM: inclusion in treatment decisions?
New era of BM treatment: systemic therapies as initial treatment approach
Entity | Target | Characteristics | Drug | IC RR (%) | EC RR (%) | OS (months) | Ref. |
---|---|---|---|---|---|---|---|
NSCLC | EGFR mutation | Asymp | Afatinib | 81.8 | 82.1 | 22.4 | |
NSCLC | EGFR mutation | Asymp | Osimertinib | 66–91.0 | 77 | 38.6 | [5] |
NSCLC | ALK translocation | Asymp | Crizotinib | 40.0–71.4 | 53.0–55.0 | Immature | |
NSCLC | ALK translocation | Asymp | Alectinib | 78.6–85.7 | NG | Immature | |
NSCLC | ALK translocation | Symp | Alectinib | 54.2 | NG | Immature | |
NSCLC | ALK translocation | Asymp. + untreat./pretreat | Lorlatinib | 63–66.7 | NG | NG | |
NSCLC | ALK translocation | NG | Brigatinib | 78.0 | NG | NR | [14] |
NSCLC | PD‑1 | Asymp | Pembrolizumab | 33.0 | 33.0 | 7.7 | [25] |
NSCLC | PD‑1 | Asymp | Nivolumab | 9.0 | 11.0 | 7.5 | [28] |
NSCLC | PDL‑1 | Asymp | Atezolizumab | NG | NG | 13.2–16.0 | |
Melanoma | BRAF mut. + MEK | Asymp./ Untreat + Pretreat | Dabrafenib + trametinib | 44–58 | 44–75.0 | 10.1–24.3 | |
Melanoma | BRAF mut. + MEK | Symp./ Untreat + Pretreat | Dabrafenib + trametinib | 59.0 | 41.0 | 11.5 | |
Melanoma | CTLA‑4 | Asymp | Ipilimumab | 16.0 | 14.0 | 7.0 | [22] |
Melanoma | CTLA‑4 | Symp | Ipilimumab | 5.0 | 5.0 | 3.7 | [22] |
Melanoma | PD‑1 | Asymp | Pembrolizumab | 22.0 | 22.0 | NR | [23] |
Melanoma | PD‑1 + CTLA‑4 | Asymp | Ipilimumab + Nivolumab | 55.0 | 50.0 | NR | |
Breast Cancer | HER‑2 | Asymp | Trastuzumab deruxtecan | 58.0 | NG | NR | [20] |
Breast Cancer | HER‑2 | Asymp | Lapatinib + Capecitabine | 31–57 | NG | 17.0 | [17] |
Breast Cancer | HER‑2 | Asymp | Trastuzumab + Pertuzumab +Docetaxel | NG | NG | 56.5 | [16] |
Breast Cancer | HER‑2 | Sympt. + Pretreat/untreat | Neratinib + Capecitabine | 33–49 | 14–43 | 13.3–21.0 | [18] |
Breast Cancer | HER‑2 | Asymp | Tucatinib + Trastuzumab +Capecitabine | 40.6 | NG | 21.9 | [19] |
Tyrosine kinase inhibitors in BM treatment
Immune checkpoint inhibitors in BM treatment
Prevention of brain metastasis: the new landmark of systemic treatment?
Primary BM prevention in NSCLC | Incidence of BM during systemic treatment (%) |
---|---|
Osimertinib | 3.0 |
Geftinib/Erlotinib | 7.0 |
Alectinib | 4.6 |
Crizotinib | 31.5 |
Radiochemotherapy + Durvalumab | 5.5 |
Radiochemotherapy + Placebo | 11.0 |
Conclusion
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Targeted and immune directed therapy presented notable intracranial response rates especially in asymptomatic brain metastases.
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Some immunotherapy and targeted therapy agents have shown primary and secondary BM prevention in clinical trials.