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Precision Medical Approaches to the Diagnoses and Management of Brain Metastases

  • Neuro-oncology (GJ Lesser, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Brain metastases represent a common and devastating complication of cancer with survival on the order of a few months in most patients. Melanoma, breast cancer, and lung cancer remain the primary disease histologies with the highest rates of metastatic spread to the brain. The incidence of brain metastases has continued to rise, likely explained by multiple factors. Improvement in progression-free survival in systemic cancer is likely attributable to advances in medical therapy, earlier supportive and symptomatic care, and improved precision around diagnosis and detection. In this context, longer survival and improved extracranial control disease has likely contributed to the increased development of metastatic spread intracranially. The foundation of management remains systemic therapy, as well as a combination of surgery and radiation therapy. In the era of targeted therapies, specific agents have demonstrated improved CNS penetration, however with varying degrees of durable responses. Most patients develop resistance to targeted agents, limiting their duration of use for patients. In this era of personalized medicine, the role of genomic characterization in cancer has been critical in the field of brain metastases, as alterations unique to both the brain metastases and its systemic predecessor have been identified, potentially offering new avenues for therapy.

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Authors and Affiliations

  1. Center for Neuro-Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Ugonma N. Chukwueke MD

  2. Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA

    Ugonma N. Chukwueke MD

  3. Department of Medical Oncology, Division of Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Priscilla K. Brastianos MD

  4. Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Priscilla K. Brastianos MD

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Ugonma N. Chukwueke declares that she has no conflict of interest. Priscilla K. Brastianos has received research funding from Merck, Pfizer, and Bristol-Myers Squibb and has received compensation from Genentech-Roche, Merck, Lilly, TESARO, and AngioChem for service as a consultant.

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Chukwueke, U.N., Brastianos, P.K. Precision Medical Approaches to the Diagnoses and Management of Brain Metastases. Curr. Treat. Options in Oncol. 20, 49 (2019). https://doi.org/10.1007/s11864-019-0649-y

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