The Evolving Landscape of Brain Metastasis

Increasing evidence from basic and clinical research suggests that colonization of the brain involves specific requirements that might not be needed extracranially. The brain microenvironment is crucial to understanding the biology of brain metastasis, and could be the source of novel therapeutic targets. New targeted therapies that cross the blood–brain barrier have improved disease control and survival of selected patients with brain metastasis. Small clinical trials suggest that immunotherapies may become another strategy to target brain metastasis. Management of brain metastasis includes maintenance of neurocognitive functions, and this questions the use of some techniques as standard-of-care (i.e., whole-brain radiation therapy). Preclinical evidences suggest that preventing experimental brain metastasis is feasible with several therapeutic approaches; however, this strategy has yet to be translated into patients. Metastasis, involving the spread of systemic cancer to the brain, results in neurologic disability and death. Current treatments are largely palliative in nature; improved therapeutic approaches represent an unmet clinical need. However, recent experimental and clinical advances challenge the bleak long-term outcome of this disease. Encompassing key recent findings in epidemiology, genetics, microenvironment, leptomeningeal disease, neurocognition, targeted therapy, immunotherapy, and prophylaxis, we review preclinical and clinical studies to provide a comprehensive picture of contemporary research and the management of secondary brain tumors. Metastasis, involving the spread of systemic cancer to the brain, results in neurologic disability and death. Current treatments are largely palliative in nature; improved therapeutic approaches represent an unmet clinical need. However, recent experimental and clinical advances challenge the bleak long-term outcome of this disease. Encompassing key recent findings in epidemiology, genetics, microenvironment, leptomeningeal disease, neurocognition, targeted therapy, immunotherapy, and prophylaxis, we review preclinical and clinical studies to provide a comprehensive picture of contemporary research and the management of secondary brain tumors.