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Management of brain metastasized non-small cell lung cancer (NSCLC) - From local treatment to new systemic therapies.

Abstract Lung cancer has the highest frequency of brain dissemination compared to all other solid tumours. Classical treatment options such as brain irradiation have started to be questioned due to lack of survival benefit and risk for severe side effects. Oncogenic driven tumours have the highest frequency of brain dissemination among NSCLC patients and available targeted therapies have shown activity both intra-and extracranially, with an acceptable toxicity profile. The recent approval of immune checkpoint inhibitors for the treatment of NSCLC has complicated treatment selection even more. Data regarding efficacy of immune therapy in the CNS are limited, though promising, and data from larger cohorts are eagerly expected. The purpose of this review is to summarize all available treatment options for brain metastatic NSCLC with an emphasis on oncogenic driven tumours. Treatment selection for brain metastasized NSCLC patients is challenging because of the detrimental effect of potential treatment related CNS side effects in patients' quality of life. Clinical decision making should be done in an individualised way, taking both clinical and molecular factors into consideration.
PMID
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Authors

Mayor MeshTerms
Keywords

Brain metastases

Brain radiotherapy

Non-small cell lung cancer

Objective response rate

Overall survival

Tyrosine kinase inhibitors

Journal Title cancer treatment reviews
Publication Year Start




PMID- 28254730
OWN - NLM
STAT- MEDLINE
DA  - 20170303
DCOM- 20170314
LR  - 20170314
IS  - 1532-1967 (Electronic)
IS  - 0305-7372 (Linking)
VI  - 54
DP  - 2017 Mar
TI  - Management of brain metastasized non-small cell lung cancer (NSCLC) - From local 
      treatment to new systemic therapies.
PG  - 122-131
LID - S0305-7372(17)30023-3 [pii]
LID - 10.1016/j.ctrv.2017.02.004 [doi]
AB  - Lung cancer has the highest frequency of brain dissemination compared to all
      other solid tumours. Classical treatment options such as brain irradiation have
      started to be questioned due to lack of survival benefit and risk for severe side
      effects. Oncogenic driven tumours have the highest frequency of brain
      dissemination among NSCLC patients and available targeted therapies have shown
      activity both intra-and extracranially, with an acceptable toxicity profile. The 
      recent approval of immune checkpoint inhibitors for the treatment of NSCLC has
      complicated treatment selection even more. Data regarding efficacy of immune
      therapy in the CNS are limited, though promising, and data from larger cohorts
      are eagerly expected. The purpose of this review is to summarize all available
      treatment options for brain metastatic NSCLC with an emphasis on oncogenic driven
      tumours. Treatment selection for brain metastasized NSCLC patients is challenging
      because of the detrimental effect of potential treatment related CNS side effects
      in patients' quality of life. Clinical decision making should be done in an
      individualised way, taking both clinical and molecular factors into
      consideration.
CI  - Copyright (c) 2017 Elsevier Ltd. All rights reserved.
FAU - Tsakonas, G
AU  - Tsakonas G
AD  - Department of Oncology, Karolinska University Hospital, Stockholm, Sweden;
      Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
      Electronic address: [email protected]
FAU - De Petris, L
AU  - De Petris L
AD  - Department of Oncology, Karolinska University Hospital, Stockholm, Sweden;
      Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
FAU - Ekman, S
AU  - Ekman S
AD  - Department of Oncology, Karolinska University Hospital, Stockholm, Sweden;
      Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170217
PL  - Netherlands
TA  - Cancer Treat Rev
JT  - Cancer treatment reviews
JID - 7502030
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Protein Kinase Inhibitors)
RN  - EC 2.7.10.1 (EGFR protein, human)
RN  - EC 2.7.10.1 (Receptor, Epidermal Growth Factor)
SB  - IM
MH  - Antineoplastic Agents/therapeutic use
MH  - Brain Neoplasms/epidemiology/*secondary/*therapy
MH  - Carcinoma, Non-Small-Cell Lung/drug therapy/*pathology
MH  - Humans
MH  - Immunotherapy/methods
MH  - Lung Neoplasms/drug therapy/*pathology
MH  - Mutation
MH  - Protein Kinase Inhibitors/pharmacology
MH  - Radiotherapy/adverse effects/methods
MH  - Receptor, Epidermal Growth Factor/antagonists & inhibitors/genetics
OTO - NOTNLM
OT  - Brain metastases
OT  - Brain radiotherapy
OT  - Non-small cell lung cancer
OT  - Objective response rate
OT  - Overall survival
OT  - Tyrosine kinase inhibitors
EDAT- 2017/03/04 06:00
MHDA- 2017/03/16 06:00
CRDT- 2017/03/04 06:00
PHST- 2016/12/01 [received]
PHST- 2017/01/31 [revised]
PHST- 2017/02/07 [accepted]
AID - S0305-7372(17)30023-3 [pii]
AID - 10.1016/j.ctrv.2017.02.004 [doi]
PST - ppublish
SO  - Cancer Treat Rev. 2017 Mar;54:122-131. doi: 10.1016/j.ctrv.2017.02.004. Epub 2017
      Feb 17.

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