Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
Curr Treat Options Oncol. 2020 Jul 28;21(9):72. doi: 10.1007/s11864-020-00759-3.
As a devastating complication of non-small cell lung cancer (NSCLC), the incidence of leptomeningeal metastasis (LM) is rising, largely due to overall longer survival of NSCLC, especially in patients with targetable molecular driver mutations. There is no clear consensus on the optimal management of LM. This review will cover recent advances in diagnosis, monitoring, and treatment of LM in NSCLC. In LM without oncogene drivers, systemic chemotherapy, intrathecal therapy, and radiation have modestly improved the clinical outcomes. Emerging data have also suggested encouraging activity of immunotherapy. At the same time, in LM with sensitizing EGFR mutations, osimertinib should be considered regardless of T790M status. Pulse erlotinib, afatinib, and newer agents with improved CNS penetration have also shown benefits. Moreover, accumulating evidences support potential benefits of molecularly targeted therapy in ALK-rearranged and other oncogene-driven NSCLC with LM. Future studies are warranted to better define the underlying mechanism, to optimize the clinical management, and to improve patient outcomes.
作为非小细胞肺癌（NSCLC）的一种严重并发症，脑膜转移（LM）的发病率正在上升，这主要是由于 NSCLC 患者的总体生存时间延长，尤其是在有可靶向分子驱动突变的患者中。对于 LM 的最佳管理方法尚无明确共识。本综述将涵盖 NSCLC 中 LM 的诊断、监测和治疗的最新进展。在没有致癌基因驱动的 LM 中，全身化疗、鞘内治疗和放疗适度改善了临床结局。新出现的数据还表明免疫治疗具有令人鼓舞的活性。与此同时，在有敏感 EGFR 突变的 LM 中，无论 T790M 状态如何，都应考虑使用奥希替尼。脉冲厄洛替尼、阿法替尼和具有更好 CNS 穿透性的新型药物也显示出获益。此外，越来越多的证据支持在有 LM 的ALK 重排和其他致癌基因驱动的 NSCLC 中进行分子靶向治疗的潜在获益。需要进一步的研究来更好地定义潜在机制，优化临床管理，改善患者结局。
