Central nervous system metastases
ICD-10 C79.3 · ICD-11 2D50

Brain Metastases in NSCLC Without an Actionable Oncogenic Driver Alteration

This protocol covers the first-line systemic management of central nervous system metastases in patients with non-small-cell lung cancer who have no actionable oncogenic driver alteration and whose brain metastases are asymptomatic or produce only mild symptoms.

Clinical Scenario

Non-small-cell lung cancer with confirmed absence of actionable oncogenic driver alteration, presenting with asymptomatic or oligosymptomatic brain metastasis. No prior systemic treatment has been given for this disease (first-line setting).

Treatment Approach — Partial Overview

The upfront systemic strategy centres on immune checkpoint inhibition, with or without the addition of platinum-based chemotherapy, determined by a key biomarker threshold — the complete eligibility criteria, combination choices, and sequencing algorithm are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

Patients with NSCLC without actionable oncogenic driver alterations with asymptomatic or oligosymptomatic BM should be treated by upfront immune checkpoint inhibition alone (PD-L1 ≥50%) or systemic chemotherapy combined with immune checkpoint inhibition (PD-L1 <50%).

For patients with advanced NSCLC without actionable oncogenic driver alterations, monotherapy with anti-programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors in case of PD-L1 positivity (>50%) or combination of immune checkpoint inhibition with platinum-based combination chemotherapy has become standard of care.

DOI: 10.1016/j.annonc.2021.07.016

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