Brain metastasis screening in the molecular age

Area of Science:

• Oncology
• Molecular Biology
• Epidemiology

Background:

• Rising incidence of brain metastases (BM) due to improved cancer survival.
• Limited current screening and surveillance guidelines for BM.
• Molecular tumor characterization offers insights into BM biology and oncogenic drivers.

Purpose of the Study:

• To review epidemiological data on BM.
• To discuss molecular characterization of BM.
• To evaluate current BM screening guidelines and identify areas for improvement.

Main Methods:

• Comprehensive literature review of epidemiological data.
• Analysis of molecular subtypes associated with high BM incidence.
• Examination of existing and emerging BM screening guidelines.

Main Results:

• Specific molecular subtypes like EGFR-mutated NSCLC, BRCA1, TN, and HER2+ breast cancers, and BRAF-mutated melanoma show higher BM incidence.
• Oncogene-addicted NSCLC and BRAF-mutated melanoma often present with asymptomatic BM.
• European guidelines recommend frequent screening for oncogene-addicted NSCLC; trials are exploring screening for breast cancer subtypes.

Conclusions:

• Molecular characterization is crucial for identifying high-risk patients for BM.
• Current screening guidelines are limited and require expansion for various molecular subtypes.
• Integrating molecular profiling into BM screening can enhance early detection and patient outcomes.