Treatment of CNS Metastases in Non-Small-Cell Lung Cancer with Actionable Oncogenic Driver Alteration

Clinical Scenario

This protocol addresses patients with non-small-cell lung cancer (NSCLC) harbouring an actionable oncogenic driver alteration — an EGFR mutation, ALK rearrangement, or ROS1 rearrangement — who present with asymptomatic or oligosymptomatic brain metastasis.

EGFR mutation ALK rearrangement ROS1 rearrangement Asymptomatic / oligosymptomatic BM First-line

Treatment Approach

In this setting, the recommended upfront strategy is systemic targeted therapy with a tyrosine kinase inhibitor matched to the specific driver alteration — the complete evidence-based selection criteria and regimen are in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2021.07.016

Patients with NSCLC with actionable oncogenic driver alterations such as EGFR or ALK or ROS1 rearrangement and asymptomatic or oligosymptomatic BM should be treated by upfront systemic targeted therapy.
Adequately designed controlled clinical trials are required to determine whether novel, potent brain-penetrant TKIs, including the third-generation TKI osimertinib, can obviate the need for early SRS.

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