Chukwueke Ugonma N, Brastianos Priscilla K
Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Division of Neuro-Oncology, Department of Neurology Massachusetts General Hospital, Boston, MA 02114, USA.
Pharmacogenomics. 2017 Apr;18(6):585-594. doi: 10.2217/pgs-2016-0170. Epub 2017 Mar 14.
CNS metastases have long been recognized as a common and late complication of systemic malignancies. They represent the most common tumor of the brain. As outcomes and overall survival improve with better tolerated and more durable responses from therapies for systemic cancers, the incidence and prevalence of brain metastases is likely to increase. Among the most common systemic cancers leading to brain metastases include lung, melanoma, breast (triple-negative histology) and renal cell cancers. To date, there has been infrequent involvement of gastrointestinal and gynecologic malignancies; however, this may also change, reflecting improvement in overall survival and therapeutic regimens. Traditional therapy of brain metastases has focused on surgery, radiation therapy or best supportive/palliative care. The advent of modern genomic techniques, including next-generation and whole-exome sequencing, has allowed for the identification of unique markers and potential drivers of metastatic pathways. This review aims to discuss and highlight the known drivers of disease and the opportunities for ultimate development of targeted therapies.
中枢神经系统转移长期以来一直被认为是全身性恶性肿瘤常见的晚期并发症。它们是最常见的脑部肿瘤。随着全身性癌症治疗的耐受性提高和反应更持久，患者的预后和总生存期得到改善，脑转移的发病率和患病率可能会增加。导致脑转移的最常见全身性癌症包括肺癌、黑色素瘤、乳腺癌（三阴性组织学类型）和肾细胞癌。迄今为止，胃肠道和妇科恶性肿瘤很少发生脑转移；然而，这一情况也可能会改变，这反映了总生存期和治疗方案的改善。脑转移的传统治疗主要集中在手术、放射治疗或最佳支持/姑息治疗。包括下一代测序和全外显子组测序在内的现代基因组技术的出现，使得能够识别独特的标志物和转移途径的潜在驱动因素。本综述旨在讨论和强调已知的疾病驱动因素以及靶向治疗最终发展的机会。
