EP11.02 CURRENT TREATMENTS AND RECENT ADVANCES FOR BRAIN METASTASES

Abstract BACKGROUND The incidence of brain metastases (BMs) has increased significantly in recent years, which can be attributed to prolonged survival due to advancements in systemic therapies and enhanced imaging technologies. Despite the availability of various treatment options, the prognosis for affected patients remains poor. METHODS This review summarizes the primary current treatment modalities for BMs and highlights recent advances in these treatment strategies. RESULTS For patients with solitary or limited brain metastases, surgical resection remains a key treatment modality. Innovations in intraoperative diagnostic tools, such as intraoperative fluorescence and handheld confocal microscopy, have improved the accuracy of tumor margin delineation. For patients with a high intracranial tumor burden, whole-brain radiotherapy (WBRT) remains a foundational treatment option; however, it is associated with notable adverse effects on cognitive function. Combining WBRT with memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, may alleviate these cognitive impairments. Stereotactic radiosurgery (SRS) offers an effective alternative for both solitary and multiple brain metastases, particularly as an adjuvant therapy following surgical resection, and is associated with a reduced risk of cognitive decline compared to WBRT. The efficacy of many chemotherapeutic agents remains limited due to the presence of the blood-brain barrier. Targeted therapies, particularly those developed for tumors with specific genetic mutations such as non-small cell lung cancer and breast cancer, have demonstrated substantial therapeutic benefits. Immune checkpoint inhibitors, a major class of immunotherapies, have led to significant advancements in the treatment of various malignancies. Additionally, the combination of immunotherapy with other treatment modalities presents promising potential. CONCLUSION Clinical management should be tailored based on the type of primary tumor, molecular characteristics, number and location of brain metastases, the patient’s systemic condition, and estimated survival. With the ongoing technological innovation and growing understanding of tumor biology, treatment of BMs is anticipated to become increasingly precise and personalized, ultimately improving patients’ outcomes.