Brain metastases and next-generation anticancer therapies: a survival guide for clinicians

Area of Science:

• Oncology
• Neurology
• Pharmacology

Background:

• Brain metastases (BMs) historically present limited treatment options and poor patient outcomes.
• The advent of novel therapies like molecular targeted agents and immunotherapy has transformed BMs management.
• These advancements introduce new complexities for clinical decision-making in BMs care.

Purpose of the Study:

• To review current evidence on checkpoint inhibitors and targeted therapies for patients with BMs.
• To provide practical guidance and potential workflows for clinicians managing BMs.
• To discuss ongoing and future challenges in BMs treatment and research.

Main Methods:

• Systematic review of current evidence on systemic therapies for BMs.
• Focus on specific cancer types: lung, breast, melanoma, and renal cell carcinoma.
• Discussion of challenges including clinical trial design and CNS drug penetration.

Main Results:

• Checkpoint inhibitors and targeted therapies show promise in managing BMs.
• Evidence supports their use in specific BMs patient populations, particularly in lung, breast, melanoma, and renal cell carcinoma.
• Improved understanding of BMs molecular characteristics is crucial for treatment efficacy.

Conclusions:

• Physicians require updated guidance to navigate complex treatment decisions for BMs.
• Novel therapies are improving outcomes, but challenges in drug delivery and trial design persist.
• This review serves as a guide to enhance clinical decision-making for BMs.