Multidisciplinary patient-centered management of brain metastases and future directions
Joshua D. Palmer, Daniel M. Trifiletti, Vinai Gondi, Michael D. Chan, Giuseppe Minniti, Chad G. Rusthoven, Steven E. Schild, Mark V. Mishra, Joseph Bovi, Nicole Williams, Maryam B. Lustberg, Paul D. Brown, Ganesh Rao, David Roberge
Abstract
The incidence of brain metastasis is increasing as improvements in systemic therapy lead to increased survival. This provides new and challenging clinical decisions for patients who are trying to balance the risk of recurrence or progression with treatment-related side effects, and it requires appropriate management strategies from multidisciplinary teams. Improvements in prognostic assessment and systemic therapy with increasing activity in the brain allow for individualized care to better guide the use of local therapies and/or systemic therapy. Here, we review the current landscape of brain-directed therapy for the treatment of brain metastasis in the context of recent improved systemic treatment options. We also discuss emerging treatment strategies including targeted therapies for patients with actionable mutations, immunotherapy, modern whole-brain radiation therapy, radiosurgery, surgery, and clinical trials.