Trial design on prophylaxis and treatment of brain metastases: Lessons learned from the EORTC Brain Metastases Strategic Meeting 2012

Spectrum of gene mutations detected by next generation exome sequencing in brain metastases of lung adenocarcinoma

“…Moreover, recent studies have detected relatively high frequencies of MET and FGFR gene amplifications in NSCLC BM and also inhibitors of these target aberrations should be studied in clinical investigations [15,27]. However, the design of such trials is not trivial and needs special consideration [28]. For example, centralised high-throughput analysis of tissue specimens and enrolment into specific clinical trials based on the given mutational pattern could solve the problems that rare mutations require screening of many patients to identify an adequate number of patients.…”

The Future of Targeted Therapies for Brain Metastases

“…Here, the substance of interest is given before the neurosurgical resection of a BM and afterwards analyzed for the intratumoral concentration [87]. High variability was observed for the concentration of capecitabine and lapatinib, indicating that the blood-tumor barrier at least partly restricts intratumoral uptake of these drugs in BM [88].…”

“…Up to 60% of patients die from their extracranial disease, rather than due to the intracranial disease progression. The intracranial progressionfree survival was a frequently used end point in previous studies; however, the control of the (life-threating) extracranial disease is not displayed [87,97].…”

“…As discussed, the treatment of established BM has to overcome several obstacles, arguing that the prevention of the outgrowth from micro-to macrometastases would facilitate a feasible treatment approach [87]. Preclinical models suggested that the induction of neoangiogenesis is one of the pivotal steps of BM outgrowth and inhibition with the VEGF antibody bevacizumab resulted in reduced BM outgrowth [109].…”

Place de la chirurgie dans la prise en charge des métastases cérébrales

“…Les sites anatomiques primitifs les plus fréquents sont le poumon et le sein [3]. Cependant, le méla-nome représente la tumeur qui a le plus haut pourcentage de métastases cérébrales par comparaison aux autres tumeurs primitives, avec 75 % des patients atteints d'une maladie disséminée qui verront se développer des métastases cérébrales [4,5]. Historiquement les métastases cérébrales étaient considérées comme une phase d'évolution terminale des patients atteints de cancer.…”