Targeted therapy of brain metastases: latest evidence and clinical implications.
Targeted therapy of brain metastases: latest evidence and clinical implications.
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DOI：
10.1177/1758834017736252
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发表时间：
2017-12
影响因子：
4.9
通讯作者：
Ahluwalia MS
中科院分区：
文献类型：
--
作者：
Di Lorenzo R;Ahluwalia MS
脑转移(BM)发生在20%-40%的癌症患者中，60%-75%的BM患者出现症状。由于人口老龄化和原发性癌症治疗的进步，患者的寿命更长，更有可能经历BM的并发症。BM的诊断大大恶化了长期存活率，多发性转移是一个较差的预后因素。直到最近，主要的治疗方法包括立体定向放射外科(SRS)、手术切除、全脑放射治疗(WBRT)或这些方法的组合。由于血脑屏障(BBB)的存在，包括脑毛细血管外排泵在内的血脑屏障的存在，使得全身化疗在治疗BM方面基本上无效。然而，在过去的十年里，研究人员已经确定了能够跨越血脑屏障的治疗剂。这些发现可能使包括手术、放射、免疫治疗和靶向治疗在内的多模式治疗方法成为可能，这可能会导致该患者群体更好地控制疾病并延长生存时间。在这篇综述中，我们讨论了目前可用的靶向治疗的证据及其在治疗中枢神经系统(CNS)受累最高的原发肿瘤中的作用，特别是非小细胞肺癌(NSCLC)、乳腺癌、黑色素瘤和肾癌。
Brain metastases (BM) occur in 20–40% of patients with cancer and 60–75% of patients with BM become symptomatic. Due to an aging population and advances in the treatment of primary cancers, patients are living longer and are more likely to experience complications from BM. The diagnosis of BM drastically worsens long-term survival rates, with multiple metastases being a poor prognostic factor. Until recently, the mainstay of treatment consisted of stereotactic radiosurgery (SRS), surgical resection, whole brain radiation therapy (WBRT), or a combination of these modalities. Systemic chemotherapy has been felt largely ineffective in the treatment of BM due to the presence of the blood–brain barrier (BBB), which includes efflux pumps on brain capillaries. Over the past decade however, researchers have identified therapeutic agents that are able to cross the BBB. These findings could make a multimodality treatment approach possible, consisting of surgery, radiation, immunotherapy, and targeted therapy, which could lead to better disease control in this patient population and prolong survival. In this review, we discuss present evidence on available targeted therapies and their role in the treatment of BM from primary tumors with the highest prevalence of central nervous system (CNS) involvement, specifically non-small cell lung cancer (NSCLC), breast cancer melanoma, and renal cell carcinoma.
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