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Role of Precision Medicine in Patients with CNS Metastasis

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Central Nervous System Metastases

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Abstract

Brain metastases are associated with poor prognosis, due to significant neurologic morbidity and current lack of a durable central nervous system (CNS)-directed therapy. Consequently, brain metastases are a critical unmet need, as the incidence is rising as treatment for systemic cancer improves. One recent breakthrough for brain metastases has been the recognition of spatial and temporal genomic heterogeneity across different metastatic sites. Recent genomic analyses have demonstrated the presence of actionable driver mutations within brain metastases not present in the paired primary tumors. This genomic heterogeneity likely contributes to the clinically observed divergent response seen with intracranial and extracranial disease burden. Another promising development has been the advent of next-generation targeted agents and immunotherapies, which have demonstrated improved tolerability and promising response rates for CNS disease. In this review, we discuss and highlight current noninvasive efforts to obtain genomic information, known genomic drivers of disease, and opportunities for targeted therapies for brain metastases.

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Author Disclosures

AE Kim has nothing to disclose.

PK Brastianos has consulted for Genentech-Roche, Lilly, Angiochem, and Tesaro, has received honoraria from Genentech-Roche and Merck, and research funding and/or clinical trial support (to MGH) from Pfizer and Merck.

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Authors and Affiliations

  1. Department of Neurology, Medical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Albert Eusik Kim

  2. CNS Metastasis Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Priscilla K. Brastianos

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  1. Albert Eusik Kim
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Correspondence to Priscilla K. Brastianos .

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Editors and Affiliations

  1. Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, Director - Brain Metastases Program, New York, NY, USA

    Rohan Ramakrishna

  2. Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Rajiv S. Magge

  3. Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Ali A. Baaj

  4. Department of Radiation Oncology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Jonathan P.S. Knisely

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Kim, A.E., Brastianos, P.K. (2020). Role of Precision Medicine in Patients with CNS Metastasis. In: Ramakrishna, R., Magge, R., Baaj, A., Knisely, J. (eds) Central Nervous System Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-42958-4_5

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  • DOI: https://doi.org/10.1007/978-3-030-42958-4_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-42957-7

  • Online ISBN: 978-3-030-42958-4

  • eBook Packages: MedicineMedicine (R0)

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