Central nervous system metastases and oligoprogression during treatment with tyrosine kinase inhibitors in oncogene-addicted non-small cell lung cancer: how to treat and when?

Janna Josephus Anna Oda Schoenmaekers, Marthe Sentijna Paats, Anne-Marie Clasina Dingemans*, Lizza Elisabeth Lucia Hendriks

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Web of Science)

Abstract

Up to 70% of non-small cell lung cancer (NSCLC) patients develop central nervous system (CNS) metastases during the course of their disease, especially those with oncogenic drivers treated with a first-generation tyrosine kinase inhibitor (TKI), because of the relatively poor CNS penetration. CNS metastases are associated with a negative impact on quality of life and survival. As, with the introduction of newer generation TKIs, the survival rates are increasing in this particular population, treatment and/or prevention of CNS metastases becomes even more relevant and the TKI with the best CNS efficacy should be selected. Unfortunately, CNS efficacy data in clinical trials are not fully comparable. Furthermore, oligoprogression to the brain without extracranial progression regularly occurs in the oncogenic driver population and both local therapy and switch of systemic therapy are possible treatment options. However, the best order of systemic and local therapy is still not precisely known. In this narrative review, we will summarize incidence and treatment of CNS metastases in oncogene driven NSCLC, including the optimal treatment of CNS oligometastatic disease (synchronous as well as oligoprogressive).

Original languageEnglish
Pages (from-to)2599-2617
Number of pages19
JournalTranslational Lung Cancer Research
Volume9
Issue number6
DOIs
Publication statusPublished - Dec 2020

Keywords

  • Non-small cell lung cancer (NSCLC)
  • central nervous system metastases (CNS metastases)
  • oligometastatic disease
  • tyrosine kinase inhibitors (TKIs)
  • DABRAFENIB PLUS TRAMETINIB
  • POSITIVE SOLID TUMORS
  • EML4-ALK FUSION GENE
  • HIGH-DOSE ERLOTINIB
  • BRAIN METASTASES
  • OPEN-LABEL
  • EGFR-MUTATION
  • LEPTOMENINGEAL METASTASES
  • CEREBROSPINAL-FLUID
  • 1ST-LINE TREATMENT

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