Brain metastasis

Question 1

Management in general

Answer 1

• generally comparable to treating metastatic disease from other primary tumor sites
• exception is for patients with a driver mutation, in whom newer-generation targeted therapies have a higher likelihood of success (can obviate need for WBRT)

Question 2

mutational patterns of brain mets vs. primary

Answer 2

the molecular mutation patterns of brain metastases have been demonstrated to be discordant with those of the primary tumor in many patients

Question 3

Efficacy of chemo vs RT for brain mets

Answer 3

Chemotherapy appears to be less effective than RT generally speaking

Question 4

Data on CPI’s for brain mets?

Answer 4

Limited (they’ve been excluded from most trials but limited evidence does suggest a durable response), so other treatment options should generally be preserved

Question 5

what is gamma knife surgery?

Answer 5

SRS