Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128 Padova, Italy; Surgical, Oncological and Gastroenterological Department, University of Padova, Via Giustiniani 2, Padova, Italy.
Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128 Padova, Italy.
Crit Rev Oncol Hematol. 2018 Aug;128:19-29. doi: 10.1016/j.critrevonc.2018.05.013. Epub 2018 May 24.
Risk of brain metastases (BM) affects a remarkable number of non-small cell lung cancer (NSCLC) patients, impacting on their quality of life (QoL) and prognosis. While tyrosine-kinase inhibitors (TKIs) showed interesting intracranial control rates in oncogene-addicted NSCLC, BM still represent an unmet need for the counterpart without driver gene mutations. For these patients, new treatment options include anti-angiogenic drugs and immune-checkpoint inhibitors, possibly combined with standard chemotherapy, even though the benefit on BM has not been clearly defined. A multidisciplinary team including neurosurgeons, medical and radiation oncologists is needed in order to integrate systemic and loco-regional strategies at the right time point. Ad-hoc designed clinical trials are slowly emerging for previously treated patients with uncontrolled BM. The aim of this review is to offer a detailed and updated picture of possible approaches for non oncogene-addicted NSCLC patients having BM, in order to support clinicians in their daily practice.
脑转移瘤（BM）的风险影响了大量非小细胞肺癌（NSCLC）患者，影响了他们的生活质量（QoL）和预后。虽然酪氨酸激酶抑制剂（TKIs）在致癌基因依赖性 NSCLC 中显示出了有趣的颅内控制率，但对于没有驱动基因突变的患者，BM 仍然是一个未满足的需求。对于这些患者，新的治疗选择包括抗血管生成药物和免疫检查点抑制剂，可能与标准化疗联合使用，尽管 BM 的获益尚未明确。为了在适当的时间点整合系统和局部区域策略，需要包括神经外科医生、内科医生和放射肿瘤学家在内的多学科团队。专门设计的临床试验正在为以前接受过治疗且 BM 未得到控制的患者缓慢出现。本文的目的是详细和更新地描述非致癌基因依赖性 NSCLC 患者发生 BM 时可能的治疗方法，以支持临床医生在日常实践中的决策。
