Metastasis to the Central Nervous System

Adrienne Boire, MD, PhD Neuro-oncology p. 1584-1601 December 2020, Vol.26, No.6 doi: 10.1212/CON.0000000000000939
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PURPOSE OF REVIEW Management of metastasis to the central nervous system (CNS) has evolved, and molecular characterization of metastatic disease is now routinely done. Targeted therapies, once few in number with limited penetration into the CNS, have multiplied in number and increased in CNS coverage. This article addresses recent advances in the evaluation and clinical management of patients with CNS metastasis.

RECENT FINDINGS Metastasis of cancer to the CNS can be diagnosed and characterized with novel techniques, including molecular analyses of the spinal fluid, so-called liquid biopsies. Resected parenchymal CNS metastases are now routinely subjected to genomic sequencing. For patients with CNS metastases displaying targetable mutations, a wide variety of treatment options are available, including deferral of radiation therapy in favor of a trial of an orally bioavailable targeted therapy or immunotherapy. For patients without a molecularly targetable lesion, local treatment in the form of radiation therapy, now most often stereotactic radiosurgery, is supplanting untargeted whole-brain radiation therapy.

SUMMARY Technologic advances in diagnosis and management have resulted in new diagnostic and therapeutic approaches to patients with metastasis to the CNS, with resulting improvements in progression-free and overall survival.

Address correspondence to Dr Adrienne Boire, Department of Neurology, Human Oncology and Pathogenesis Program, Brain Tumor Center, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, [email protected].

RELATIONSHIP DISCLOSURE: Dr Boire has received research/grant support from the Damon Runyon Cancer Research Foundation, the Pershing Square Sohn Cancer Research Alliance, The Pew Charitable Trusts, and the W. M. Keck Foundation.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Boire discusses the unlabeled/investigational intrathecal use of trastuzumab to treat leptomeningeal metastasis.

© 2020 American Academy of Neurology.