Molecular Target Therapy for Brain Metastases in Non Small Cell Lung Cancer--An Interview with Dr. Christina Baik at ASCO 2015

           Reroduced from Oncology Frontier

Christina Baik, MD MPH Assistant Professor
Thoracic/Head and Neck
Division of Medical Oncology
Seattle Cancer Care Alliance
UW School of Medicine

Oncology Frontier(肿瘤瞭望): What‘s the role of molecularly targeted therapy for brain metastases andleptomeningeal disease in lung cancer?

Dr Baik: Right now, the data we have are specifically for EGFR-positive and ALK-positive patients.

We know the first-line TKIs do cross into the brain to a degree and can result in some disease control, at least initially.

For ALK-positive patients with small volume CNS disease, you could start them with crizotinib upfront if they have asymptomatic disease. We know that that can lead to about six months of disease control in the brain but they do need to be followed closely.

For EGFR-positive patients, it seems that they may respond a bit better in terms of disease control on upfront erlotinib.

My personal approach in practice has been to give erlotinib rather than gefitinib mainly because erlotinib does get into the brain a little better then gefitinib.

In patients who are on the first-line TKIs and progress, the ALK-positive patients do have the option of the second-generation TKIs. In the US, ceritinib is the FDA approved drug and there are others in development.

In the EGFR field, there are no next-generation TKIs with known CNS activity, so for those patients, if they have symptomatic disease progression, I would have them see the radiation oncology colleagues. Otherwise, there are new agents being developed that have CNS activity.

ASCO 2105
McCormick Place, Chicago

How to optimize treatment strategies for lung cancer brain metastases? 

Dr Baik: That’s a complex question because you need a close collaboration with a radiation oncologist to determine the timing of radiation which depends on whether the patient has asymptomatic or symptomatic disease and it also depends on the systemic disease burden.

If the patient is really sick from their systemic disease and the CNS disease is minimal, then the focus needs to be on the treatment of the systemic disease. On the othet hand, if the patient had symptomic CNS disease, then starting with CNS-directed radiotherapy followed by systemic thrapy would make sense.

It requires an individual patient approach and discussion with the collaboration of other disciplines.

References:

1. ASCO访谈]分子靶向药物治疗肺癌脑转移和软脑膜疾病 原创 2015-06-03 C.S.Baik 肿瘤瞭望© 公众微信

2. CS Baik et al. Targeted Therapy for Brain Metastases in EGFR-Mutated and ALK-Rearranged Non-Small-Cell Lung Cancer. J Thorac Oncol. 2015 Jun 23.