Skip to main content

Advertisement

SpringerLink
Log in

Advances in Management of Brain and Leptomeningeal Metastases

  • Neuro-Oncology (P. Wen, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The management of brain and leptomeningeal metastases has changed significantly over the past decade.

Recent Findings

Historically, radiation therapy had been the mainstay of treatment. Several strategies to limit toxicities with radiation have been developed in the recent years. Increasingly systemic therapy options are being considered an important therapeutic option for CNS metastases. Numerous novel small molecule inhibitors and immunotherapy agents have intracranial activity to varying degrees, in addition to good extracranial disease control.

Summary

Overall, the prognosis of select patients with CNS metastases has improved over the past several years with advent of new therapeutic strategies. Systemic therapy options with CNS benefit should be considered in select patients with small and asymptomatic CNS metastases. Further areas of research focus on molecular alterations predisposing to CNS metastases, identification of small molecule inhibitors with CNS activity, and the combination of radiation therapy and immunotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):48–54.

    Article  PubMed  Google Scholar 

  2. Fox BD, Cheung VJ, Patel AJ, Suki D, Rao G. Epidemiology of metastatic brain tumors. Neurosurg Clin N Am. 2011;22(1):1–6 v.

    Article  PubMed  Google Scholar 

  3. Taillibert S, Chamberlain MC. Leptomeningeal metastasis. Handb Clin Neurol. 2018;149:169–204.

    Article  PubMed  Google Scholar 

  4. Venur VA, Ahluwalia MS. Prognostic scores for brain metastasis patients: use in clinical practice and trial design. Chin Clin Oncol. 2015;4(2):18.

    PubMed  Google Scholar 

  5. Beauchesne P. Intrathecal chemotherapy for treatment of leptomeningeal dissemination of metastatic tumours. Lancet Oncol. 2010;11(9):871–9.

    Article  CAS  PubMed  Google Scholar 

  6. Ramalingam SS, Vansteenkiste J, Planchard D, Cho BC, Gray JE, Ohe Y, et al. Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med. 2020;382(1):41–50.

    Article  CAS  PubMed  Google Scholar 

  7. Peters S, Camidge DR, Shaw AT, Gadgeel S, Ahn JS, Kim DW, et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med. 2017;377(9):829–38.

    Article  CAS  PubMed  Google Scholar 

  8. Shaw AT, Solomon BJ, Chiari R, Riely GJ, Besse B, Soo RA, et al. Lorlatinib in advanced ROS1-positive non-small-cell lung cancer: a multicentre, open-label, single-arm, phase 1-2 trial. Lancet Oncol. 2019;20(12):1691–701.

    Article  CAS  PubMed  Google Scholar 

  9. Bachelot T, Romieu G, Campone M, Dieras V, Cropet C, Dalenc F, et al. Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. Lancet Oncol. 2013;14(1):64–71.

    Article  CAS  PubMed  Google Scholar 

  10. Freedman RA, Gelman RS, Anders CK, Melisko ME, Parsons HA, Cropp AM, et al. TBCRC 022: a phase II trial of neratinib and capecitabine for patients with human epidermal growth factor receptor 2-positive breast cancer and brain metastases. J Clin Oncol. 2019;37(13):1081–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Murthy RK, Loi S, Okines A, Paplomata E, Hamilton E, Hurvitz SA, et al. Tucatinib, trastuzumab, and capecitabine for HER2-positive metastatic breast cancer. N Engl J Med 2019.

  12. Kumthekar P, Tang SC, Brenner AJ, Kesari S, Piccioni DE, Anders CK, Carrillo J, Chalasani P, Kabos P, Puhalla S, Tkaczuk K, Garcia AA, Ahluwalia MS, Wefel JS, Lakhani N, Ibrahim N ANG1005, a brain penetrating peptide-drug conjugate, shows activity in patients with breast cancer with leptomeningeal carcinomatosis and recurrent brain metastases. Clin Cancer Res 2020.

  13. McArthur GA, Maio M, Arance A, Nathan P, Blank C, Avril MF, et al. Vemurafenib in metastatic melanoma patients with brain metastases: an open-label, single-arm, phase 2, multicentre study. Ann Oncol. 2017;28(3):634–41.

    Article  CAS  PubMed  Google Scholar 

  14. Davies MA, Saiag P, Robert C, Grob JJ, Flaherty KT, Arance A, et al. Dabrafenib plus trametinib in patients with BRAF(V600)-mutant melanoma brain metastases (COMBI-MB): a multicentre, multicohort, open-label, phase 2 trial. Lancet Oncol. 2017;18(7):863–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Goldberg SB, Gettinger SN, Mahajan A, Chiang AC, Herbst RS, Sznol M, et al. Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial. Lancet Oncol. 2016;17(7):976–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kluger HM, Chiang V, Mahajan A, Zito CR, Sznol M, Tran T, et al. Long-term survival of patients with melanoma with active brain metastases treated with pembrolizumab on a phase II trial. J Clin Oncol. 2019;37(1):52–60.

    Article  CAS  PubMed  Google Scholar 

  17. Tawbi HA, Forsyth PA, Algazi A, Hamid O, Hodi FS, Moschos SJ, et al. Combined nivolumab and ipilimumab in melanoma metastatic to the brain. N Engl J Med. 2018;379(8):722–30.

    Article  CAS  PubMed  Google Scholar 

  18. Long GV, Atkinson V, Lo S, Sandhu S, Guminski AD, Brown MP, et al. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomised phase 2 study. Lancet Oncol. 2018;19(5):672–81.

    Article  CAS  PubMed  Google Scholar 

  19. Ahn MJ, Chiu CH, Cheng Y, Han JY, Goldberg SB, Greystoke A, et al. Osimertinib for patients with leptomeningeal metastases associated with EGFR T790M-positive advanced NSCLC: the AURA leptomeningeal metastases analysis. J Thorac Oncol 2019.

  20. Yang JCH, Kim SW, Kim DW, Lee JS, Cho BC, Ahn JS, et al. Osimertinib in patients with epidermal growth factor receptor mutation-positive non-small-cell lung cancer and leptomeningeal metastases: the BLOOM study. J Clin Oncol. 2019:Jco1900457.

  21. Kumthekar P, Lassman AB, Lin N, Grimm S, Gradishar W, Pentsova E, et al. LPTO-02. Intrathecal (IT) trastuzumab (T) for the treatment of leptomeningeal disease (LM) in patients (PTS) with human epidermal receptor-2 positive (HER2+) cancer: a multicenter phase 1/2 study. Neuro-Oncology Advances. 2019;1(Supplement_1):i6–i.

    Article  Google Scholar 

  22. Brastianos PK, Prakadan S, Alvarez-Breckenridge C, Lee EQ, Tolaney SM, Nayak L, et al. Phase II study of pembrolizumab in leptomeningeal carcinomatosis. Journal of Clinical Oncology. 2018;36(15_suppl):2007.

    Article  Google Scholar 

  23. Banks WA. From blood-brain barrier to blood-brain interface: new opportunities for CNS drug delivery. Nat Rev Drug Discov. 2016;15(4):275–92.

    Article  CAS  PubMed  Google Scholar 

  24. Lee BP, Imhof BA. Lymphocyte transmigration in the brain: a new way of thinking. Nat Immunol. 2008;9(2):117–8.

    Article  CAS  PubMed  Google Scholar 

  25. Neman J, Termini J, Wilczynski S, Vaidehi N, Choy C, Kowolik CM, et al. Human breast cancer metastases to the brain display GABAergic properties in the neural niche. Proc Natl Acad Sci U S A. 2014;111(3):984–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Smalley I, Law V, Wyatt C, Evernden B, Fang B, Koomen JM, et al. Proteomic analysis of CSF from patients with leptomeningeal melanoma metastases identifies signatures associated with disease progression and therapeutic resistance. Clin Cancer Res. 2020.

  27. Brastianos PK, Carter SL, Santagata S, Cahill DP, Taylor-Weiner A, Jones RT, et al. Genomic characterization of brain metastases reveals branched evolution and potential therapeutic targets. Cancer Discov. 2015;5(11):1164–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hulsbergen AFC, Claes A, Kavouridis VK, Ansaripour A, Nogarede C, Hughes ME, et al. Subtype switching in breast cancer brain metastases: a multicenter analysis. Neuro-Oncology. 2020.

  29. Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, et al. Estrogen, progesterone and HER2 receptor discordance between primary tumor and brain metastases in breast cancer and its effect on treatment and survival. Neuro-Oncology. 2020.

  30. Quail DF, Joyce JA. The microenvironmental landscape of brain tumors. Cancer Cell. 2017;31(3):326–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Berghoff AS, Fuchs E, Ricken G, Mlecnik B, Bindea G, Spanberger T, et al. Density of tumor-infiltrating lymphocytes correlates with extent of brain edema and overall survival time in patients with brain metastases. Oncoimmunology. 2016;5(1):e1057388.

    Article  PubMed  CAS  Google Scholar 

  32. Priego N, Zhu L, Monteiro C, Mulders M, Wasilewski D, Bindeman W, et al. STAT3 labels a subpopulation of reactive astrocytes required for brain metastasis. Nat Med. 2018;24(7):1024–35.

    Article  CAS  PubMed  Google Scholar 

  33. Boire A, Brastianos PK, Garzia L, Valiente M. Brain metastasis. Nat Rev Cancer. 2020;20(1):4–11.

    Article  CAS  PubMed  Google Scholar 

  34. Lin NU, Lee EQ, Aoyama H, Barani IJ, Barboriak DP, Baumert BG, et al. Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol. 2015;16(6):e270–8.

    Article  PubMed  Google Scholar 

  35. Kaufmann TJ, Smits M, Boxerman J, Huang R, Barboriak DP, Weller M, Chung C, Tsien C, Brown PD, Shankar L, Galanis E, Gerstner E, van den Bent MJ, Burns TC, Parney IF, Dunn G, Brastianos PK, Lin NU, Wen PY, Ellingson BM Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases (BTIP-BM). Neuro-Oncology. 2020.

  36. Le Rhun E, Devos P, Boulanger T, Smits M, Brandsma D, Ruda R, et al. The RANO Leptomeningeal Metastasis Group proposal to assess response to treatment: lack of feasibility and clinical utility and a revised proposal. Neuro-Oncology. 2019;21(5):648–58.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mouraviev A, Detsky J, Sahgal A, Ruschin M, Lee YK, Karam I, et al. Use of radiomics for the prediction of local control of brain metastases after stereotactic radiosurgery. Neuro Oncol. 2020.

  38. Le Rhun E, Weller M, Brandsma D, Van den Bent M, de Azambuja E, Henriksson R, et al. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours. Ann Oncol. 2017;28(suppl_4):iv84–99.

    Article  PubMed  Google Scholar 

  39. Milojkovic Kerklaan B, Pluim D, Bol M, Hofland I, Westerga J, van Tinteren H, et al. EpCAM-based flow cytometry in cerebrospinal fluid greatly improves diagnostic accuracy of leptomeningeal metastases from epithelial tumors. Neuro-Oncology. 2016;18(6):855–62.

    Article  PubMed  CAS  Google Scholar 

  40. van Bussel MTJ, Pluim D, Milojkovic Kerklaan B, Bol M, Sikorska K, Linders DTC, et al. Circulating epithelial tumor cell analysis in CSF in patients with leptomeningeal metastases. Neurology. 2020;94(5):e521–e8.

    Article  PubMed  CAS  Google Scholar 

  41. Brown PD, Pugh S, Laack NN, Wefel JS, Khuntia D, Meyers C, et al. Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro-Oncology. 2013;15(10):1429–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Brown PD, Gondi V, Pugh S, Tome WA, Wefel JS, Armstrong TS, et al. Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases: phase III trial NRG oncology CC001. J Clin Oncol. 2020:Jco1902767.

  43. Serizawa T, Yamamoto M, Higuchi Y, Sato Y, Shuto T, Akabane A, et al. Local tumor progression treated with Gamma Knife radiosurgery: differences between patients with 2-4 versus 5-10 brain metastases based on an update of a multi-institutional prospective observational study (JLGK0901). J Neurosurg. 2019:1–10.

  44. Yamamoto M, Serizawa T, Higuchi Y, Sato Y, Kawagishi J, Yamanaka K, et al. A multi-institutional prospective observational study of stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901 study update): irradiation-related complications and long-term maintenance of mini-mental state examination scores. Int J Radiat Oncol Biol Phys. 2017;99(1):31–40.

    Article  PubMed  Google Scholar 

  45. Baliga S, Garg MK, Fox J, Kalnicki S, Lasala PA, Welch MR, et al. Fractionated stereotactic radiation therapy for brain metastases: a systematic review with tumour control probability modelling. Br J Radiol. 2017;90(1070):20160666.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1040–8.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049–60.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Engels EA, Schmid CH, Terrin N, Olkin I, Lau J. Heterogeneity and statistical significance in meta-analysis: an empirical study of 125 meta-analyses. Stat Med. 2000;19(13):1707–28.

    Article  CAS  PubMed  Google Scholar 

  49. Prabhu RS, Turner BE, Asher AL, Marcrom SR, Fiveash JB, Foreman PM, et al. A multi-institutional analysis of presentation and outcomes for leptomeningeal disease recurrence after surgical resection and radiosurgery for brain metastases. Neuro Oncol. 2019.

  50. Patel KR, Burri SH, Asher AL, Crocker IR, Fraser RW, Zhang C, et al. Comparing preoperative with postoperative stereotactic radiosurgery for resectable brain metastases: a multi-institutional analysis. Neurosurgery. 2016;79(2):279–85.

    Article  PubMed  Google Scholar 

  51. Wong RF, Khosla R, Moore JH, Kuwada SK. Consider colonoscopy for young patients with hematochezia. J Fam Pract. 2004;53(11):879–84.

    PubMed  Google Scholar 

  52. Wong S, Lidums I, Rosty C, Ruszkiewicz A, Parry S, Win AK, et al. Findings in young adults at colonoscopy from a hospital service database audit. BMC Gastroenterol. 2017;17(1):56.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Chaunzwa TL, Deng D, Leuthardt EC, Tatter SB, Mohammadi AM, Barnett GH, et al. Laser thermal ablation for metastases failing radiosurgery: a multicentered retrospective study. Neurosurgery. 2018;82(1):56–63.

    Article  PubMed  Google Scholar 

  54. Hong CS, Deng D, Vera A, Chiang VL. Laser-interstitial thermal therapy compared to craniotomy for treatment of radiation necrosis or recurrent tumor in brain metastases failing radiosurgery. J Neuro-Oncol. 2019;142(2):309–17.

    Article  CAS  Google Scholar 

  55. Wang BX, Ou W, Mao XY, Liu Z, Wu HQ, Wang SY. Impacts of EGFR mutation and EGFR-TKIs on incidence of brain metastases in advanced non-squamous NSCLC. Clin Neurol Neurosurg. 2017;160:96–100.

    Article  PubMed  Google Scholar 

  56. Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med. 2018;378(2):113–25.

    Article  CAS  PubMed  Google Scholar 

  57. Thapa B, Lauko A, Desai K, Venur VA, Ahluwalia MS. Novel systemic treatments for brain metastases from lung cancer. Curr Treat Options Neurol. 2018;20(11):48.

    Article  PubMed  Google Scholar 

  58. Rangachari D, Yamaguchi N, VanderLaan PA, Folch E, Mahadevan A, Floyd SR, et al. Brain metastases in patients with EGFR-mutated or ALK-rearranged non-small-cell lung cancers. Lung Cancer. 2015;88(1):108–11.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Gadgeel SM, Gandhi L, Riely GJ, Chiappori AA, West HL, Azada MC, et al. Safety and activity of alectinib against systemic disease and brain metastases in patients with crizotinib-resistant ALK-rearranged non-small-cell lung cancer (AF-002JG): results from the dose-finding portion of a phase 1/2 study. Lancet Oncol. 2014;15(10):1119–28.

    Article  CAS  PubMed  Google Scholar 

  60. Kim DW, Tiseo M, Ahn MJ, Reckamp KL, Hansen KH, Kim SW, et al. Brigatinib in patients with crizotinib-refractory anaplastic lymphoma kinase-positive non-small-cell lung cancer: a randomized, multicenter phase II trial. J Clin Oncol. 2017;35(22):2490–8.

    Article  CAS  PubMed  Google Scholar 

  61. Wu YL, Yang JC, Kim DW, Lu S, Zhou J, Seto T, et al. Phase II study of crizotinib in East Asian patients with ROS1-positive advanced non-small-cell lung cancer. J Clin Oncol. 2018;36(14):1405–11.

    Article  CAS  PubMed  Google Scholar 

  62. Fecci PE, Champion CD, Hoj J, McKernan CM, Goodwin CR, Kirkpatrick JP, et al. The evolving modern management of brain metastasis. Clin Cancer Res. 2019;25(22):6570–80.

    Article  PubMed  Google Scholar 

  63. Tabouret E, Chinot O, Metellus P, Tallet A, Viens P, Goncalves A. Recent trends in epidemiology of brain metastases: an overview. Anticancer Res. 2012;32(11):4655–62.

    PubMed  Google Scholar 

  64. Lien EA, Wester K, Lonning PE, Solheim E, Ueland PM. Distribution of tamoxifen and metabolites into brain tissue and brain metastases in breast cancer patients. Br J Cancer. 1991;63(4):641–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87(5):586–92.

    Article  CAS  PubMed  Google Scholar 

  66. Cortes J, Rugo HS, Awada A, Twelves C, Perez EA, Im SA, et al. Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial. Breast Cancer Res Treat. 2017;165(2):329–41.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Venur VA, Funchain P, Kotecha R, Chao ST, Ahluwalia MS. Changing treatment paradigms for brain metastases from melanoma-part 1: diagnosis, prognosis, symptom control, and local treatment. Oncology (Williston Park). 2017;31(8):602–6.

    Google Scholar 

  68. Holbrook K, Lutzky J, Davies MA, Davis JM, Glitza IC, Amaria RN, et al. Intracranial antitumor activity with encorafenib plus binimetinib in patients with melanoma brain metastases: a case series. Cancer. 2020;126(3):523–30.

    Article  CAS  PubMed  Google Scholar 

  69. Drago JZ, Lawrence D, Livingstone E, Zimmer L, Chen T, Giobbie-Hurder A, et al. Clinical experience with combination BRAF/MEK inhibitors for melanoma with brain metastases: a real-life multicenter study. Melanoma Res. 2019;29(1):65–9.

    Article  CAS  PubMed  Google Scholar 

  70. Ahmed KA, Stallworth DG, Kim Y, Johnstone PA, Harrison LB, Caudell JJ, et al. Clinical outcomes of melanoma brain metastases treated with stereotactic radiation and anti-PD-1 therapy. Ann Oncol. 2016;27(3):434–41.

    Article  CAS  PubMed  Google Scholar 

  71. Williams NL, Wuthrick EJ, Kim H, Palmer JD, Garg S, Eldredge-Hindy H, et al. Phase 1 study of ipilimumab combined with whole brain radiation therapy or radiosurgery for melanoma patients with brain metastases. Int J Radiat Oncol Biol Phys. 2017;99(1):22–30.

    Article  CAS  PubMed  Google Scholar 

  72. Lagares-Garcia JA, Kurek S, Collier B, Diaz F, Schilli R, Richey J, et al. Colonoscopy in octogenarians and older patients. Surg Endosc. 2001;15(3):262–5.

    Article  CAS  PubMed  Google Scholar 

  73. Lewis JD, Brown A, Localio AR, Schwartz JS. Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis. Ann Intern Med. 2002;136(2):99–110.

    Article  PubMed  Google Scholar 

  74. Lin NU, Prowell T, Tan AR, Kozak M, Rosen O, Amiri-Kordestani L, et al. Modernizing clinical trial eligibility criteria: recommendations of the American Society of Clinical Oncology-Friends of Cancer Research Brain Metastases Working Group. J Clin Oncol. 2017;35(33):3760–73.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Seattle Cancer Care Alliance, Division of Oncology, Department of Medicine, University of Washington Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Vyshak Alva Venur

  2. Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Ugonma N. Chukwueke & Eudocia Q. Lee

  3. Brigham and Women’s Hospital, Boston, MA, 02215, USA

    Ugonma N. Chukwueke & Eudocia Q. Lee

  4. Harvard Medical School, Boston, MA, 02215, USA

    Ugonma N. Chukwueke & Eudocia Q. Lee

Authors
  1. Vyshak Alva Venur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ugonma N. Chukwueke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eudocia Q. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eudocia Q. Lee.

Ethics declarations

Conflict of Interest

Vyshak Alva Venur, Ugonma N. Chukwueke, and Eudocia Q. Lee each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neuro-Oncology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Venur, V.A., Chukwueke, U.N. & Lee, E.Q. Advances in Management of Brain and Leptomeningeal Metastases. Curr Neurol Neurosci Rep 20, 26 (2020). https://doi.org/10.1007/s11910-020-01039-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-020-01039-1

Keywords

Search

Navigation