Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Expert Rev Anticancer Ther. 2021 Mar;21(3):325-339. doi: 10.1080/14737140.2021.1851200. Epub 2020 Nov 30.
: Brain metastases (BM) are a frequent complication of metastatic cancer. Due to the wider availability and application of screening procedures, an increasing fraction of patients are diagnosed at the asymptomatic stage. The introduction of immune checkpoint inhibitors and targeted therapies has revolutionized treatment in several frequently BM-causing entities like metastatic lung cancer, melanoma and breast cancer. However, registered trials of new targeted and immunotherapy mostly excluded patients with BM resulting in limited knowledge of the intracranial efficacy of new systemic agents.: The present review highlights recent advances in systemic therapies for the treatment and prophylaxis of the three leading BM causing tumors: NSCLC, melanoma and breast cancer.: High intracranial efficacy was observed for several next-generation tyrosine kinase inhibitors as well as immune checkpoint inhibitors, especially in patients with asymptomatic disease. Ongoing discussions addressed the need for local therapies in patients with asymptomatic BM and the availability of systemic therapy with high intracranial efficacy. Further BM-specific studies as well as BM-specific endpoints in registered trials are needed to define the role of systemic monotherapies in patients with BM.
脑转移（BM）是转移性癌症的常见并发症。由于筛查程序的广泛应用，越来越多的无症状患者被诊断出来。免疫检查点抑制剂和靶向治疗的引入已经彻底改变了几种经常导致 BM 的实体瘤的治疗方法，如转移性肺癌、黑色素瘤和乳腺癌。然而，新的靶向和免疫治疗的注册试验大多排除了 BM 患者，导致对新的全身药物在颅内的疗效知之甚少。
本文综述了治疗和预防三种主要导致 BM 的肿瘤（非小细胞肺癌、黑色素瘤和乳腺癌）的系统治疗的最新进展。
对于几种新一代酪氨酸激酶抑制剂和免疫检查点抑制剂，观察到颅内疗效较高，尤其是在无症状疾病患者中。正在进行的讨论涉及到无症状 BM 患者需要局部治疗以及是否可以获得颅内疗效高的全身治疗。需要进一步的 BM 特异性研究和注册试验中的 BM 特异性终点来确定全身单药治疗在 BM 患者中的作用。
