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New developments in brain metastases
Anna S Berghoff1, Matthias Preusser2
1Department of Medicine I, Medical University of Vienna, Vienna, Austria Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Abstract:
Patients with brain metastases (BM) are a population of high clinical need for new therapeutic approaches due to, as yet, very impaired survival prognosis. However, only few clinical trials have specifically addressed this prognostically highly heterogeneous patient population. New developments in the treatment of BM patients aim to reduce the side effects of local therapies, for example, by redefining the indications for stereotactic radiosurgery and whole-brain radiotherapy (WBRT) or introducing new applications like hippocampal sparing WBRT. Furthermore, systemic therapies become a more important treatment approach in patients harboring targetable mutations, as recent BM-specific endpoints in several phase III trials have shown promising intracranial efficacy. In addition, immune-checkpoint inhibitors show promising intracranial efficacy, particularly in patients with melanoma and non-small lung cancer BM. Here, we provide a review on the recent new developments in the local and systemic therapy approaches in BM patients.
Insights
New treatments for brain metastases (BM) focus on improving survival. Advances in local therapies and systemic treatments, including targeted therapies and immune-checkpoint inhibitors, offer new hope for patients with BM.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Medical Oncology
Background:
- Brain metastases (BM) represent a significant clinical challenge with poor prognoses.
- Limited clinical trials have addressed the heterogeneity of BM patient populations.
- Existing treatments for BM often involve significant side effects.
Purpose of the Study:
- To review recent advancements in local and systemic therapies for brain metastases.
- To highlight novel approaches in managing BM patients.
- To discuss the evolving landscape of BM treatment strategies.
Main Methods:
- Literature review of recent clinical trials and therapeutic developments in BM.
- Analysis of new indications and applications for local therapies like stereotactic radiosurgery and whole-brain radiotherapy (WBRT).
- Evaluation of systemic therapy approaches, including targeted mutations and immune-checkpoint inhibitors.
Main Results:
- Refined indications for stereotactic radiosurgery and whole-brain radiotherapy (WBRT), including hippocampal sparing WBRT, aim to reduce side effects.
- Systemic therapies show promising intracranial efficacy, especially in patients with targetable mutations.
- Immune-checkpoint inhibitors demonstrate efficacy in melanoma and non-small cell lung cancer BM.
Conclusions:
- Recent developments offer improved therapeutic strategies for brain metastases.
- Combining local and systemic treatments may enhance outcomes for BM patients.
- Further research is needed to optimize treatment paradigms for this heterogeneous population.
