TY - JOUR
T1 - Central nervous system metastases in advanced non-small cell lung cancer
T2 - A review of the therapeutic landscape
AU - Weller, Michael
AU - Remon, Jordi
AU - Rieken, Stefan
AU - Vollmuth, Philipp
AU - Ahn, Myung-Ju
AU - Minniti, Giuseppe
AU - Le Rhun, Emilie
AU - Westphal, Manfred
AU - Brastianos, Priscilla K.
AU - Soo, Ross A.
AU - Kirkpatrick, John P.
AU - Goldberg, Sarah B.
AU - Ohrling, Katarina
AU - Hegi-Johnson, Fiona
AU - Hendriks, Lizza E. L.
PY - 2024/11/1
Y1 - 2024/11/1
N2 - Up to 40% of patients with non-small cell lung cancer (NSCLC) develop central nervous system (CNS) metastases. Current treatments for this subgroup of patients with advanced NSCLC include local therapies (surgery, stereotactic radiosurgery, and, less frequently, whole-brain radiotherapy), targeted therapies for oncogene-addicted NSCLC (small molecules, such as tyrosine kinase inhibitors, and antibody-drug conjugates), and immune checkpoint inhibitors (as monotherapy or combination therapy), with multiple new drugs in development. However, confirming the intracranial activity of these treatments has proven to be challenging, given that most lung cancer clinical trials exclude patients with untreated and/or progressing CNS metastases, or do not include prespecified CNS-related endpoints. Here we review progress in the treatment of patients with CNS metastases originating from NSCLC, examining local treatment options, systemic therapies, and multimodal therapeutic strategies. We also consider challenges regarding assessment of treatment response and provide thoughts around future directions for managing CNS disease in patients with advanced NSCLC.
AB - Up to 40% of patients with non-small cell lung cancer (NSCLC) develop central nervous system (CNS) metastases. Current treatments for this subgroup of patients with advanced NSCLC include local therapies (surgery, stereotactic radiosurgery, and, less frequently, whole-brain radiotherapy), targeted therapies for oncogene-addicted NSCLC (small molecules, such as tyrosine kinase inhibitors, and antibody-drug conjugates), and immune checkpoint inhibitors (as monotherapy or combination therapy), with multiple new drugs in development. However, confirming the intracranial activity of these treatments has proven to be challenging, given that most lung cancer clinical trials exclude patients with untreated and/or progressing CNS metastases, or do not include prespecified CNS-related endpoints. Here we review progress in the treatment of patients with CNS metastases originating from NSCLC, examining local treatment options, systemic therapies, and multimodal therapeutic strategies. We also consider challenges regarding assessment of treatment response and provide thoughts around future directions for managing CNS disease in patients with advanced NSCLC.
KW - Non-small cell lung cancer
KW - CNS metastases
KW - Stereotactic radiosurgery
KW - Tyrosine kinase inhibitors
KW - Small molecules
KW - Immune checkpoint inhibitors
KW - POSTOPERATIVE STEREOTACTIC RADIOSURGERY
KW - TYROSINE KINASE INHIBITORS
KW - WHOLE-BRAIN RADIOTHERAPY
KW - CLINICAL-PRACTICE GUIDELINES
KW - NIVOLUMAB PLUS IPILIMUMAB
KW - EGFR-MUTANT NSCLC
KW - OPEN-LABEL
KW - LEPTOMENINGEAL CARCINOMATOSIS
KW - INTRACRANIAL EFFICACY
KW - SURGICAL-MANAGEMENT
U2 - 10.1016/j.ctrv.2024.102807
DO - 10.1016/j.ctrv.2024.102807
M3 - (Systematic) Review article
SN - 0305-7372
VL - 130
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
M1 - 102807
ER -