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Current Treatment Options for Breast Cancer Brain Metastases

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

Opinion statement

In the past, the standard of care for treatment of BM was whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. There has been a greater role for medical therapies in the last two decades due to the discovery of driver mutations and corresponding targeted therapies. These innovations have dramatically altered the approach to treating these patients. Some of the important mutations include epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations in small cell lung cancer, human epidermal growth factor receptor (HER2) mutation in breast cancer, and BRAF mutation in melanoma. Disease-specific graded prognostic assessments have identified prognostic factors for each of the major tumor types associated with BM. These reflect the increased treatment sensitivity of these tumors to specific agents. Furthermore, there is a difference in the genetic makeup of BM compared to their primary tumor. Genomic studies of BM patients comparing somatic point mutations and copy number variations with their primary tumor have demonstrated that while both the primary tumor and BM share a number of common mutations, BM can often develop distinct mutations. Therefore, there is a need to individualize systemic therapies in BM. Several organizations including the Food and Drug Administration and the American Society of Clinical Oncology now emphasize the inclusion of BM patients in various phases of clinical drug development.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. PGY3 Internal Medicine Resident, Department of Internal Medicine, Cleveland Clinic Akron General, 1, Akron General Ave, Akron, OH, 44307, USA

    Arrvind Raghunath MD

  2. PGY1 Internal Medicine Resident, Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, NA10, Cleveland, OH, 44195, USA

    Kunal Desai MD, MBA, MS

  3. Department of Medicine, Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, S73, Cleveland, OH, 44195, USA

    Manmeet S. Ahluwalia MD

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Correspondence to Manmeet S. Ahluwalia MD.

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Arrvind Raghunath declares that he has no conflict of interest. Kunal Desai declares that he has no conflict of interest. Manmeet S. Ahluwalia has received research funding from Incyte, Bristol-Myers Squibb, AstraZeneca, TRACON, Novartis, Novocure, AbbVie, Pharmacyclics, Merck, and Bayer; has received compensation from Incyte, Bristol-Myers Squibb, AstraZeneca, Novocure, Monteris Medical, Caris Life Sciences, MR Solutions, AbbVie, CBT Pharmaceuticals, Flatiron Health, Varian Medical Systems, and MimiVax for service as a consultant; has received compensation from VBI Vaccines for participating on a data and safety monitoring board; and has stock options in MimiVax and Doctible.

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Raghunath, A., Desai, K. & Ahluwalia, M.S. Current Treatment Options for Breast Cancer Brain Metastases. Curr. Treat. Options in Oncol. 20, 19 (2019). https://doi.org/10.1007/s11864-019-0618-5

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