Medical Management of Non–Small Cell Lung Cancer Brain Metastases in the Modern Era

Brain metastases are a common complication among patients with non-small cell lung cancer and are historically associated with significant morbidity and limited survival. Although surgery and radiation therapy remain essential pillars in the clinical management of brain metastases, the development of several pharmacologic agents with activity in the central nervous system has broadened the role of systemic therapies for treating brain metastases. There is accumulating evidence that, in the appropriate clinical scenarios, systemic therapies may be used to manage both intracranial and extracranial disease while delaying local therapy and mitigating potential treatment-related morbidity. Determining the optimal treatment approach requires careful consideration of the intracranial tumor burden, location of lesions, pathologic and molecular profile, local and systemic therapy options, and overall prognosis. This review will provide updates on the medical management of non-small cell lung cancer brain metastases, with a focus on recent advances in systemic therapy options.