Brain metastases are cancer cells that have spread to the brain from primary tumors in other organs in the body. An estimated 24-45% of all cancer patients in the United States have brain metastases.
Treatment options depend on the primary tumor type, and the stage of the disease. Therapies include:
Radiation Therapy (WBRT whole brain radiation therapy, focal beam, and stereotactic radiation therapy)
Radiation therapy has become a mainstream therapy for brain metastasis. Radiation therapy includes WBRT and stereotactic radiosurgery. Stereotactic radiosurgery is a more preferred treatment modality for radiation resistant lesions such as non-small cell lung cancer, renal cell carcinoma, and melanoma. It is also frequently used in brain metastasis from breast cancer
Chemotherapy A variety of chemotherapeutic agents have been used to treat brain metastasis from lung, breast, and melanoma, including cisplatin, cyclophosphamide, etoposide, fluorouracil (5FU), ifosfamide, irinotecan, mitomycin, prednisone, temozolomide, teniposide, and vinorelbine
Most tumors that metastasize to the brain are not chemo-sensitive, though small-cell lung cancer, breast cancer, and lymphoma respond to chemotherapy. In most cases several therapeutic agents are used in combination and in conjunction with whole-brain radiation therapy
Combined Therapies In many cases, numerous agents are used in combination and in conjunction with whole-brain radiation therapy
Targeted Therapies Temozolomide has recently been used as a single agent to treat brain metastasis from breast cancer. Complete remission was achieved in 36% of patients, and an additional 58% had a partial response.
Tyrosine kinase inhibitors and monoclonal antibodies Gefitinib and erlotinib, epidermal growth factor receptor (EGFR) inhibitors have been used to treat non-small cell lung cancers that metastasize to the brain, especially if they have the EGFR mutation.
The use of lapatinib in combination with capecitabine has been used to treat HER2 positive brain metastasis, and vemurafenib is used in BRAF V600E–positive melanoma with brain metastasis. New research has suggested that sorafenib or sunitinib can lower the incidence of metastasis of renal cell carcinoma to the brain.
Monoclonal antibodies such as trastuzumab is commonly used to treat metastatic breast cancer, and Ipilimumab is administered to treat metastatic melanoma to the brain.