Department of Oncology, University College London Hospital, London, UK.
Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.
Ann Oncol. 2017 Dec 1;28(12):2923-2931. doi: 10.1093/annonc/mdx481.
Advances in the last decade in genomic profiling and the identification of druggable targets amenable to biological agents have transformed the management and survival of a subgroup of patients with brain metastasis in non-small-cell lung cancer. In parallel, clinicians have reevaluated the role of whole brain radiotherapy in selected patients with brain metastases to reduce neurocognitive toxicity. Continual progress in this understudied field is required: optimization of the sequence of schedules for therapies in patients with brain metastases of differing genomic profiles, focusing on new strategies to overcome mechanisms of biological resistance and increasing drug penetrability into the central nervous system. This review summarizes the field to date and possible treatment strategies based on current evidence.
在过去十年中,基因组分析和可靶向生物制剂药物靶点的鉴定方面的进展改变了非小细胞肺癌脑转移亚组患者的治疗和生存情况。与此同时,临床医生重新评估了全脑放疗在特定脑转移患者中的作用,以降低神经认知毒性。这一研究不足的领域需要不断取得进展:优化不同基因组特征脑转移患者治疗方案的顺序,重点关注克服生物耐药机制和增加药物穿透中枢神经系统的新策略。本文综述了该领域的最新进展,并根据现有证据提出了可能的治疗策略。