Prog Neurol Surg. 2019 May 16;34:125-137. doi: 10.1159/000493057. [Epub ahead of print]

Targeted Therapies for Brain Metastases.

Niranjan A1, Lunsford LD2, Ahluwalia MS3.

Author information

1

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA, niraax@UPMC.EDU.

2

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

3

Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Abstract

The most common primary cancers that metastasize to the brain are lung cancer, breast cancer, and melanoma. The established management approaches for brain metastasis include stereotactic radiosurgery, fractionated radiation therapy, and surgical resection. In the past the role of medical therapies in brain metastases was limited. In the last decade, our understanding of molecular drivers of brain metastases and CNS penetration of drugs across the blood-brain barrier has improved. The molecular targeted tyrosine kinase inhibitors have shown effectiveness in brain metastases with activating mutations from non-small cell lung cancer, breast cancer, and melanoma. More recently, immunotherapies have also shown efficacy in the management of these patients. These agents can be effective for both intracranial as well as extracranial disease and are being actively employed in this patient population.