Mechanisms and therapy for cancer metastasis to the brain

摘要: Advances in chemotherapy and targeted therapies have improved survival cancer patients with an increase of the incidence newly diagnosed brain metastases (BMs). Intracranial are symptomatic 60-70% patients. Magnetic resonance imaging (MRI) gadolinium is more sensitive than computed tomography advanced neuroimaging techniques been increasingly used detection, treatment planning, follow-up BM. Apart from morphological analysis, most effective tool for characterizing BM immunohistochemistry. Molecular alterations not always reflect those primary tumor. More sophisticated methods tumor analysis detecting circulating biomarkers fluids (liquid biopsy), including DNA, cells, extracellular vesicles, containing DNA macromolecules (microRNA), shown promise regarding response progression. The choice therapeutic approaches guided by prognostic scores (Recursive Partitioning Analysis diagnostic-specific Graded Prognostic Assessment-DS-GPA). benefit surgical resection seems limited to subgroup controlled systemic disease good performance status. Leptomeningeal (LMD) can be a complication, especially posterior fossa undergoing "piecemeal" resection. Radiosurgery cavity may offer comparable local control as postoperative whole-brain radiotherapy (WBRT). WBRT alone now only single or multiple BMs amenable surgery radiosurgery, poor factors. To reduce neurocognitive sequelae intensity modulated hippocampal sparing, pharmacological (memantine donepezil) investigated. In last decade, multitude molecular abnormalities discovered. Approximately 33% non-small cell lung (NSCLC) tumors epidermal growth factor receptor mutations develop BMs, which targetable different generations tyrosine kinase inhibitors (TKIs: gefitinib, erlotinib, afatinib, icotinib, osimertinib). Other "druggable" seen up 5% NSCLC rearrangements "anaplastic lymphoma kinase" gene TKI (crizotinib, ceritinib, alectinib, brigatinib, lorlatinib). human 2-positive, breast widely (trastuzumab, trastuzumab-emtansine, lapatinib-capecitabine, neratinib). Novel immunotherapeutic agents also revolutionized management melanoma (ipilimumab, nivolumab, pembrolizumab, BRAF dabrafenib vemurafenib).