Toward Precision Medicine in Brain Metastases

Anna S. Berghoff; Priscilla K. Brastianos

doi:10.1055/s-0038-1627469

Seminars in Neurology, Table of Contents

Semin Neurol 2018; 38(01): 095-103
DOI: 10.1055/s-0038-1627469

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Toward Precision Medicine in Brain Metastases

Anna S. Berghoff

¹Clinical Cooperation Unit Neuro-Oncology, German Cancer Research Center, Heidelberg, Germany

²Clinical Unit for Experimental Oncology Therapy, Thoraxklinik, University of Heidelberg, Heidelberg, Germany

,

Priscilla K. Brastianos

³Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

⁴Division of Neuro-Oncology, Department of Neurology, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

⁵Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

⁶Broad Institute, Boston, Massachusetts

› Author Affiliations

Abstract

Brain metastases (BMs) reflect an area of high clinical need, as up to 40% of patients with metastatic cancer will develop this morbid and highly fatal complication. Historically, treatment strategies have relied on local approaches including radiosurgery, whole-brain radiotherapy, and neurosurgical resection. Recently, targeted and immune-modulating therapies have shown promising responses and have been introduced in the clinical management of patients with BMs. Recent improvements in genomic technologies have enriched our understanding of BMs and have demonstrated that BMs present with significant genetic divergence from the originating primary tumor, such that potentially targetable genetic alterations are detected only in the BMs. However, this genetic divergence also results in genetic alterations associated with resistance to targeted therapies. A deeper insight on the genetic alterations of BMs and the interaction with the brain microenvironment will likely reveal new treatment targets, moving toward more precision therapies for patients with BMs.

Keywords

brain metastases - branched evolution - targeted therapies - clinical trials

Full Text

References

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