Current challenges in the management of nonsmall cell lung cancer brain metastases

[摘要] In May 2019, the third European Respiratory Society research seminar of the Thoracic Oncology Assembly entitled “New biomarkers, molecules and therapeutic sequences for non-small cell lung carcinoma (NSCLC) in the era of precision medicine” was held in Paris, France. The previous two seminars of the Thoracic Oncology Assembly were on targeted therapy (2015) [1] and immune checkpoint inhibitors (ICI, 2017) [2]. During this seminar, breakout sessions on difficult situations were organised. One of the most original and useful was on the current challenges in brain metastases (BM) management, that we propose to share with European Respiratory Journal readers. BM are associated with decreased quality of life (QoL) and poorer survival compared to patients without BM [3]. BM incidence is increasing, probably due to more screening, better imaging techniques and longer survival because of improved systemic therapies, such as tyrosine kinase inhibitors (TKIs) and ICI (with or without chemotherapy). Therefore, BM management becomes more and more important. However, BM screening and treatment practices differ, partly because of heterogeneous access to imaging and radiotherapy facilities, and heterogeneous access to newer systemic treatments [4]. Furthermore, guidelines for BM management recommendations are not consensual (reviewed by LEVY et al. [4]), and high-level evidence regarding screening and treatment is scarce. Randomised trials specifically including NSCLC BM patients are largely lacking, and patients with untreated and/or unstable, or even all, BM were excluded from most clinical trials (reviewed by EL RASSY et al. [5] and MCCOACH et al. [6]).

[学科分类] 呼吸医学