The Evolving Modern Management of Brain Metastasis.
Peter E FecciCosette D ChampionJacob HojCourtney M McKernanC Rory GoodwinJohn P KirkpatrickCarey K AndersAnn Marie PendergastJohn H SampsonPublished in: Clinical cancer research : an official journal of the American Association for Cancer Research (2019)
The incidence of brain metastases is increasing as cancer therapies improve and patients live longer, providing new challenges to the multidisciplinary teams that care for these patients. Brain metastatic cancer cells possess unique characteristics that allow them to penetrate the blood-brain barrier, colonize the brain parenchyma, and persist in the intracranial environment. In addition, brain metastases subvert the innate and adaptive immune system, permitting evasion of the antitumor immune response. Better understanding of the above mechanisms will allow for development and delivery of more effective therapies for brain metastases. In this review, we outline the molecular mechanisms underlying development, survival, and immunosuppression of brain metastases. We also discuss current and emerging treatment strategies, including surgery, radiation, disease-specific and mutation-targeted systemic therapy, and immunotherapy.
Keyphrases
- brain metastases
- small cell lung cancer
- immune response
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- healthcare
- resting state
- white matter
- squamous cell carcinoma
- risk factors
- stem cells
- coronary artery disease
- quality improvement
- palliative care
- dendritic cells
- radiation therapy
- optical coherence tomography
- patient reported outcomes
- pain management
- blood brain barrier
- cell therapy
- cerebral ischemia
- health insurance
- smoking cessation
- radiation induced