Lung Cancer and CNS Metastases| Gregory J Riely, MD, PhD

published 1 month ago by Dr Neil Love

Consensus or Controversy? The Integration of Novel Therapies into the Interdisciplinary Management of Non-Small Cell Lung Cancer with CNS Metastases: Our most recent one-on-one interview with Dr Riely as a supplement to a CME symposium held during the 24th Annual Meeting and Education Day of the Society for Neuro-Oncology featuring expert comments on the application of emerging research to patient care. Improved treatment outcomes and impact on the incidence of brain metastases in patients with non-small cell lung cancer (NSCLC) (00:00) Case (Dr Gubens): A man in his mid-50s with adenocarcinoma of the lung with an EGFR exon 19 deletion mutation, asymptomatic brain lesions and significant systemic burden (03:43) Clinical care of patients with NSCLC brain metastases alone and no systemic disease (06:23) Diagnosis of radiation necrosis (11:42) Activity of the third-generation EGFR tyrosine kinase inhibitor (TKI) osimertinib in patients with NSCLC and CNS metastases (13:17) Mechanism of action of osimertinib in the brain and effect on CNS disease progression (15:43) Risks of whole-brain radiation therapy; role of hippocampus sparing and memantine administration in minimizing the adverse effects of whole-brain radiation therapy (17:42) Comparison of survival outcomes with stereotactic radiation therapy and EGFR TKIs (22:24) Case (Dr Gubens): A man in his late 40s with metastatic NSCLC with an ALK rearrangement and large asymptomatic brain metastases (24:46) Role of other TKIs (ie, BRAF, MET, HER2 inhibitors) in NSCLC with CNS metastases (28:15) Antitumor effect of ALK inhibitors in patients with CNS metastases (31:58) Practical issues in the management of CNS metastases: edema, symptomatic CNS metastases and oligoprogression (33:21) Managing CNS metastases with leptomeningeal involvement (36:44) Case (Dr Gubens): A man in his early 40s with metastatic adenocarcinoma of the lung with an EGFR L858R mutation responds to first-line osimertinib for 2 years but then develops 2 new asymptomatic punctate parenchymal metastases and extensive leptomeningeal involvement (39:01) Symptoms of CNS metastases with leptomeningeal involvement; challenges in diagnosis (43:13) Case (Dr Gubens): A woman in her late 60s with metastatic adenocarcinoma of the lung, no targetable tumor mutations and a PD-L1 tumor proportion score (TPS) of 80% (44:53) Outlook on the use of TKIs for patients with CNS metastases (48:42) Potential for combining TKIs with chemotherapy in the management of CNS metastases (50:19) Activity and safety of EGFR TKIs in combination with anti-PD-1/PD-L1 antibodies (52:14) CME information and select publications

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