Brain metastases from lung cancer: recent advances and novel therapeutic opportunities

Metastatic intracranial progression drastically impacts prognosis, therapeutic considerations and quality of life. The increasing incidence of lung cancer patients developing brain metastases (BM) parallels the incorporation of more effective systemic agents and improved surveillance. Our evolving knowledge of BM pathophysiology, along with advancements in surgical, radiotherapy and systemic therapy options, is rapidly changing prognostication and treatment paradigms. Optimal management of BM in the modern era is patient-specific, dependent on performance status, comorbidities, intracranial and extracranial disease burden, leptomeningeal disease, and the presence of targetable mutations. The purpose of this review is to provide a detailed overview of the detection, prognostication, and multidisciplinary, management of BM arising from non-small cell lung cancer and small cell lung cancer. We discuss contemporary evidence and active clinical trials supporting a wide array of treatment options, including surgery, radiosurgery, memory-avoidance whole brain radiation, craniospinal irradiation, chemotherapy, targeted agents and immunotherapy. Multidisciplinary paradigms will continue to evolve as currently accruing randomized trials evaluating these promising treatments options mature.