Intracranial Metastatic Disease: Present Challenges, Future Opportunities

Overview

Journal Front Oncol

Specialty Oncology

Date 2022 Mar 25

PMID 35330715

Authors

Alyssa Y Li

Karolina Gaebe

Katarzyna J Jerzak

Parneet K Cheema

Arjun Sahgal

Sunit Das

Affiliations

Soon will be listed here.

Abstract

Intracranial metastatic disease (IMD) is a prevalent complication of cancer that significantly limits patient survival and quality of life. Over the past half-century, our understanding of the epidemiology and pathogenesis of IMD has improved and enabled the development of surveillance and treatment algorithms based on prognostic factors and tumor biomolecular characteristics. In addition to advances in surgical resection and radiation therapy, the treatment of IMD has evolved to include monoclonal antibodies and small molecule antagonists of tumor-promoting proteins or endogenous immune checkpoint inhibitors. Moreover, improvements in the sensitivity and specificity of imaging as well as the development of new serological assays to detect brain metastases promise to revolutionize IMD diagnosis. In this review, we will explore current treatment principles in patients with IMD, including the emerging role of targeted and immunotherapy in select primary cancers, and discuss potential areas for further investigation.

Citing Articles

Brain metastasis burden and management in patients with small cell lung cancer in Canada: a retrospective, population-based cohort study.

Gaebe K, Erickson A, Chen S, Menjak I, Lok B, Sahgal A EClinicalMedicine. 2024; 77:102871.

PMID: 39416386 PMC: 11474380. DOI: 10.1016/j.eclinm.2024.102871.

Development of an optimized machine learning approach for assessing brain metastatic burden in preclinical models.

Rappaport J, Chen Q, McGuire T, Daugherty-Lopes A, Goldszmid R bioRxiv. 2024; .

PMID: 39372751 PMC: 11451615. DOI: 10.1101/2024.08.21.608131.

Diabetes Mellitus Is a Strong Independent Negative Prognostic Factor in Patients with Brain Metastases Treated with Radiotherapy.

Jeong S, Poudyal S, Klagges S, Kuhnt T, Papsdorf K, Hambsch P Cancers (Basel). 2023; 15(19).

PMID: 37835539 PMC: 10571851. DOI: 10.3390/cancers15194845.

Long-term survival in patients with brain metastases-clinical characterization of a rare scenario.

Hugel M, Stohr J, Kuhnt T, Nagler F, Papsdorf K, Klagges S Strahlenther Onkol. 2023; 200(4):335-345.

PMID: 37646818 PMC: 10965568. DOI: 10.1007/s00066-023-02123-4.

Personalized radiotherapy of brain metastases: survival prediction by means of dichotomized or differentiated blood test results?.

Nieder C, Andratschke N, Grosu A Front Oncol. 2023; 13:1156161.

PMID: 37114122 PMC: 10126728. DOI: 10.3389/fonc.2023.1156161.

References

Tawbi H, Schadendorf D, Lipson E, Ascierto P, Matamala L, Castillo Gutierrez E . Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma. N Engl J Med. 2022; 386(1):24-34. PMC: 9844513. DOI: 10.1056/NEJMoa2109970. View

Shaw M, Ball D . Treatment of brain metastases in lung cancer: strategies to avoid/reduce late complications of whole brain radiation therapy. Curr Treat Options Oncol. 2013; 14(4):553-67. DOI: 10.1007/s11864-013-0258-0. View

Wang J, Elder J . Techniques for Open Surgical Resection of Brain Metastases. Neurosurg Clin N Am. 2020; 31(4):527-536. DOI: 10.1016/j.nec.2020.06.003. View

Shaw A, Bauer T, de Marinis F, Felip E, Goto Y, Liu G . First-Line Lorlatinib or Crizotinib in Advanced -Positive Lung Cancer. N Engl J Med. 2020; 383(21):2018-2029. DOI: 10.1056/NEJMoa2027187. View

Attia A, Rapp S, Case L, DAgostino R, Lesser G, Naughton M . Phase II study of Ginkgo biloba in irradiated brain tumor patients: effect on cognitive function, quality of life, and mood. J Neurooncol. 2012; 109(2):357-63. PMC: 3752650. DOI: 10.1007/s11060-012-0901-9. View

Pestalozzi B, Brignoli S . Trastuzumab in CSF. J Clin Oncol. 2000; 18(11):2349-51. DOI: 10.1200/JCO.2000.18.11.2349. View

Meyers C, Smith J, Bezjak A, Mehta M, Liebmann J, Illidge T . Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol. 2004; 22(1):157-65. DOI: 10.1200/JCO.2004.05.128. View

Sneed P, Mendez J, Vemer-van den Hoek J, Seymour Z, Ma L, Molinaro A . Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg. 2015; 123(2):373-86. DOI: 10.3171/2014.10.JNS141610. View

Levin V, Bidaut L, Hou P, Kumar A, Wefel J, Bekele B . Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys. 2010; 79(5):1487-95. PMC: 2908725. DOI: 10.1016/j.ijrobp.2009.12.061. View

10.

Chang E, Wefel J, Hess K, Allen P, Lang F, Kornguth D . Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009; 10(11):1037-44. DOI: 10.1016/S1470-2045(09)70263-3. View

11.

Patchell R, Tibbs P, Walsh J, Dempsey R, Maruyama Y, Kryscio R . A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990; 322(8):494-500. DOI: 10.1056/NEJM199002223220802. View

12.

Ruben J, Dally M, Bailey M, Smith R, McLean C, Fedele P . Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Phys. 2006; 65(2):499-508. DOI: 10.1016/j.ijrobp.2005.12.002. View

13.

Schmid P, Adams S, Rugo H, Schneeweiss A, Barrios C, Iwata H . Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med. 2018; 379(22):2108-2121. DOI: 10.1056/NEJMoa1809615. View

14.

Okwan-Duodu D, Pollack B, Lawson D, Khan M . Role of radiation therapy as immune activator in the era of modern immunotherapy for metastatic malignant melanoma. Am J Clin Oncol. 2013; 38(1):119-25. DOI: 10.1097/COC.0b013e3182940dc3. View

15.

Silk A, Bassetti M, West B, Tsien C, Lao C . Ipilimumab and radiation therapy for melanoma brain metastases. Cancer Med. 2014; 2(6):899-906. PMC: 3892394. DOI: 10.1002/cam4.140. View

16.

Kuo T, Recht L . Optimizing therapy for patients with brain metastases. Semin Oncol. 2006; 33(3):299-306. DOI: 10.1053/j.seminoncol.2006.03.005. View

17.

Metro G, Foglietta J, Russillo M, Stocchi L, Vidiri A, Giannarelli D . Clinical outcome of patients with brain metastases from HER2-positive breast cancer treated with lapatinib and capecitabine. Ann Oncol. 2010; 22(3):625-630. DOI: 10.1093/annonc/mdq434. View

18.

Rodriguez de Dios N, Counago F, Murcia-Mejia M, Rico-Oses M, Calvo-Crespo P, Samper P . Randomized Phase III Trial of Prophylactic Cranial Irradiation With or Without Hippocampal Avoidance for Small-Cell Lung Cancer (PREMER): A GICOR-GOECP-SEOR Study. J Clin Oncol. 2021; 39(28):3118-3127. DOI: 10.1200/JCO.21.00639. View

19.

Ahn M, Han J, Lee K, Kim S, Kim D, Lee Y . Lazertinib in patients with EGFR mutation-positive advanced non-small-cell lung cancer: results from the dose escalation and dose expansion parts of a first-in-human, open-label, multicentre, phase 1-2 study. Lancet Oncol. 2019; 20(12):1681-1690. DOI: 10.1016/S1470-2045(19)30504-2. View

20.

Brastianos P, Kim A, Wang N, Lee E, Ligibel J, Cohen J . Palbociclib demonstrates intracranial activity in progressive brain metastases harboring cyclin-dependent kinase pathway alterations. Nat Cancer. 2022; 2(5):498-502. PMC: 10644914. DOI: 10.1038/s43018-021-00198-5. View