The prognosis of patients with CNS metastases depends on several parameters including the molecular assessment of the disease.

In patients with clear cell renal cell carcinoma and untreated central nervous system metastases, intracranial response to nivolumab monotherapy is restricted to those with a limited tumor burden, suggest phase II findings.

An analysis of the KRYSTAL-1 study indicates that adagrasib has intracranial activity in people with KRAS G12C-mutated non-small-cell lung cancer and untreated CNS metastases.

Stereotactic radiosurgery is associated with better long-term cognitive function than whole-brain radiotherapy in people with a limited number of brain metastases, suggests a secondary analysis of a clinical trial.

Furthermore, when looking only at the intracranial efficacy of entrectinib, the ORR was 49.0% for all 51 patients with confirmed CNS metastases at baseline, increasing to 60.9% among the 23 patients with baseline CNS metastases who were given entrectinib as first-line treatment.

Patients with advanced ALK- positive non-small-cell lung cancer derive prolonged progression-free survival from first-line treatment with lorlatinib regardless of the presence of brain metastases, post-hoc analyses indicate.

Management of HER2-positive breast cancer with brain metastases The brain metastases guideline also updates a previous version from 2018, and the authors note that “[t]hese recommendations supplement existing guidelines that address brain metastases for patients with other types of cancer and the companion recommendations for systemic therapy.”

Etirinotecan pegol does not improve the overall survival of people with breast cancer and stable brain metastases relative to physicians’ choice of single-agent chemotherapy, show trial data.

The antibody–drug conjugate trastuzumab deruxtecan induces a high intracranial response rate among women with HER2-positive breast cancer and active brain metastases, TUXEDO-1 study findings indicate.

Individuals with non-small-cell lung cancer and brain metastases may benefit from treatment with immune checkpoint inhibitors plus radiotherapy after neurosurgical resection, findings indicate.

The second-generation irreversible pan-HER tyrosine kinase inhibitor pyrotinib in combination with capecitabine shows promising activity against brain metastases in women with HER2-positive metastatic breast cancer, say researchers.

At diagnosis of advanced disease, 9% of patients ( n  = 41) had CNS metastases; at EGFR-TKI initiation, 14% of patients ( n  = 68) had CNS metastases.

Furthermore, subgroup analyses showed similar results regardless of the number of lines and types of previous therapy, presence of central nervous system (CNS) metastases, and types of HER2 insertion mutations.

Cabozantinib has “considerable” intracranial activity in patients with advanced renal cell carcinoma and brain metastases, say the authors of a chart review published in JAMA Oncology .

Treatment with carboplatin and pemetrexed plus atezolizumab shows promise for people with nonsquamous non-small-cell lung cancer and asymptomatic, untreated brain metastases, phase 2 study findings indicate.

The PFS benefit associated with the lurbinectedin combination was especially pronounced in the subgroup of patients with a CTFI greater than 180 days and those without baseline CNS metastases, with significant hazard ratios for progression or death of 0.47 and 0.79, respectively.

Thus, entrectinib expands the range of treatment options for advanced NTRK+ solid tumours and ROS1+ NSCLC, and may be of particular value in patients with existing CNS metastases and those who are at risk of developing CNS metastases.

The most common site for recurrence was the lung, occurring at rates of 6% and 18% in the osimertinib and placebo groups, respectively, but the researchers focused their analysis on CNS recurrences because CNS metastases are associated with significant morbidity, reported Masahiro Tsuboi, from the National Cancer Center Hospital East in Kashiwa, Japan.

Masahiro Tsuboi discusses the clinical implications of the primary and CNS analyses of the ADAURA trial of adjuvant osimertinib in EGFR-mutated non-small-cell lung cancer and outlines the key next steps.

Exploratory analyses from the KAMILLA trial indicate that trastuzumab emtansine may be a feasible option for HER2-positive breast cancer patients who have brain metastases.