The percentage of brain metastases at initial diagnosis ranges from 10–30% in patients with non-small cell lung cancer (NSCLC), with increasing incidence throughout the disease course. These brain metastases can cause motor dysfunction, mental dysfunction, seizures, headaches, nausea and vomiting and can thus severely hamper the patient’s quality of life. Historically, the presence of brain metastasis is a poor prognostic factor, and its control may prolong the prognosis of the patient. Brain metastases can be addressed with local therapy (such as surgery and radiotherapy), or with systemic therapy using classical anticancer drugs. Unfortunately, one of the major limitations in defining the optimal initial treatment for NSCLC patients with brain metastases is that patients with untreated brain metastases were often excluded from randomised clinical trials evaluating systemic therapies.1 Furthermore, also a drug’s inability to penetrate the blood-brain barrier (BBB) can result in treatment resistance.2 The most suitable treatment should be determined during a multidisciplinary consult and should be based on histologic type, the general condition of the patient, and the size and number of brain metastases.2 This mini-review discusses the systemic management of patients with NSCLC and brain metastases, with a particular focus on patients with actionable genomic alterations.
