Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, USA.
University of Iowa Hospitals and Clinics, Iowa, USA.
Curr Neurol Neurosci Rep. 2017 Apr;17(4):37. doi: 10.1007/s11910-017-0741-2.
Brain metastases are the most common intracranial tumors in adults. Historically, the median survival after the diagnosis of brain metastases has been dismal and medical therapies had a limited role in the management of these patients.
The advent of targeted therapy has ushered in an era of increased hope for patients with brain metastases. The most common malignancies that result in brain metastases-melanoma, lung cancer, and breast cancer, often have actionable mutations, which make them good candidates for targeted systemic therapy. These brain metastases have been shown to have relevant and sometimes divergent genetic alterations, and there has been a resurgence of interest in targeted drug delivery to the brain by using standard or pulsatile dosing to achieve adequate concentration in the brain. An increased understanding of oncogenic alterations, a surge in targeted drug development with good blood barrier penetration, and inclusion of patients with active brain metastases on clinical trials have led to improved outcomes for patients with brain metastases.
脑转移瘤是成年人中最常见的颅内肿瘤。从历史上看，脑转移瘤诊断后的中位生存期较差，且医学治疗在这些患者的治疗中作用有限。
靶向治疗的出现为脑转移瘤患者带来了新的希望。导致脑转移瘤的最常见恶性肿瘤——黑色素瘤、肺癌和乳腺癌，通常存在可操作的突变，这使它们成为靶向全身治疗的良好候选者。这些脑转移瘤显示出相关的、有时是不同的遗传改变，人们重新产生了通过使用标准或脉冲剂量将靶向药物递送到大脑中以在大脑中达到足够浓度的兴趣。对致癌改变的认识不断加深，具有良好血脑屏障穿透性的靶向药物的开发热潮，以及将有活跃脑转移的患者纳入临床试验，都使脑转移瘤患者的预后得到了改善。
