PDF(Pubmed)
Abstract：
This review discusses the topic of prevention of brain metastases from the most frequent solid tumor types, i.e., lung cancer, breast cancer and melanoma. Within each tumor type, the risk of brain metastasis is related to disease status and molecular subtype (i.e., EGFR-mutant non-small cell lung cancer, HER2-positive and triple-negative breast cancer, BRAF and NRAF-mutant melanoma). Prophylactic cranial irradiation is the standard of care in patients in small cell lung cancer responsive to chemotherapy but at the price of late neurocognitive decline. More recently, several molecular agents with the capability to target molecular alterations driving tumor growth have proven as effective in the prevention of secondary relapse into the brain in clinical trials. This is the case for EGFR-mutant or ALK-rearranged non-small cell lung cancer inhibitors, tucatinib and trastuzumab-deruxtecan for HER2-positive breast cancer and BRAF inhibitors for melanoma. The need for screening with an MRI in asymptomatic patients at risk of brain metastases is emphasized.
摘要：
这篇综述讨论了预防最常见的实体瘤类型的脑转移的主题，即，肺癌,乳腺癌和黑色素瘤.在每种肿瘤类型中，脑转移的风险与疾病状态和分子亚型有关(即，EGFR突变型非小细胞肺癌,HER2阳性和三阴性乳腺癌，BRAF和NRAF突变黑色素瘤）。预防性颅骨照射是对化疗有反应的小细胞肺癌患者的标准护理，但代价是晚期神经认知能力下降。最近,在临床试验中,一些能够靶向分子改变驱动肿瘤生长的分子药物已被证明在预防继发性脑复发方面是有效的.EGFR突变或ALK重排的非小细胞肺癌抑制剂就是这种情况。图卡替尼和曲妥珠单抗-deruxtecan治疗HER2阳性乳腺癌，BRAF抑制剂治疗黑色素瘤。强调对脑转移风险的无症状患者进行MRI筛查的必要性。
