Abstract
SUMMARY: Treatment options for patients who develop brain metastases secondary to non-small-cell lung cancer have rapidly expanded in recent years. As a key adjunct to surgical and radiation therapy options, systemic therapies are now a critical component of the oncologic management of metastatic CNS disease in many patients with non-small-cell lung cancer. The aim of this review article was to provide a guide for radiologists, outlining the role of systemic therapies in metastatic non-small-cell lung cancer, with a focus on tyrosine kinase inhibitors. The critical role of the blood-brain barrier in the development of systemic therapies will be described. The final sections of this review will provide an overview of current imaging-based guidelines for therapy response. The utility of the Response Assessment in Neuro-Oncology criteria will be discussed, with a focus on how to use the response criteria in the assessment of patients treated with systemic and traditional therapies.
ABBREVIATIONS:
- ALK
- anaplastic lymphoma kinase
- CTLA-4
- cytotoxic T-lymphocyte-associated protein 4
- EGFR
- epidermal growth factor receptor
- EML4
- echinoderm microtubule-associated protein-like 4
- ICI
- immune checkpoint inhibitor
- NSCLC
- non-small-cell lung cancer
- PD-1
- programmed cell death protein 1
- PFS
- progression-free survival
- PRES
- posterior reversible encephalopathy syndrome
- QALY
- quality-adjusted life years
- RANO
- Response Assessment in Neuro-Oncology
- RECIST
- Response Evaluation Criteria in Solid Tumors
- ROS1
- C-ras oncogene 1
- SRS
- stereotactic radiosurgery
- TKI
- tyrosine kinase inhibitor
- WBRT
- whole-brain radiation therapy
- © 2020 by American Journal of Neuroradiology
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