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.
本综述探讨了最常见实体肿瘤类型（即肺癌、乳腺癌和黑色素瘤）脑转移的预防问题。在不同肿瘤类型中，脑转移风险与疾病状态及分子亚型相关（例如EGFR突变非小细胞肺癌、HER2阳性及三阴性乳腺癌、BRAF与NRAF突变黑色素瘤）。预防性全脑放疗是对化疗敏感的小细胞肺癌患者的标准治疗方案，但需以晚期神经认知功能下降为代价。近年来，多项临床试验证实，多种能够靶向驱动肿瘤生长的分子改变的药物可有效预防脑部继发性复发，例如针对EGFR突变或ALK重排非小细胞肺癌的抑制剂、用于HER2阳性乳腺癌的图卡替尼与曲妥珠单抗-德鲁替康，以及用于黑色素瘤的BRAF抑制剂。本文强调了对存在脑转移风险的无症状患者进行磁共振成像筛查的必要性。
肿瘤(癌症)患者之家