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Review
. 2019 Nov 15;25(22):6570-6580.
doi: 10.1158/1078-0432.CCR-18-1624. Epub 2019 Jun 18.

The Evolving Modern Management of Brain Metastasis

Peter E Fecci  1   2 , Cosette D Champion  1   2 , Jacob Hoj  3 , Courtney M McKernan  3 , C Rory Goodwin  1   2 , John P Kirkpatrick  1   2   4 , Carey K Anders  5 , Ann Marie Pendergast  3 , John H Sampson  6   2
Affiliations
Review

The Evolving Modern Management of Brain Metastasis

Peter E Fecci et al. Clin Cancer Res. .

Abstract

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.

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Conflict of interest statement

Conflicts of Interest: J.H.S. has an equity interest in Annias Immunotherapeutics, which has licensed intellectual property from Duke related to the use of the pepCMV vaccine in the treatment of glioblastoma multiforme. J.H.S. has an equity interest in Istari Oncology, which has licensed intellectual property from Duke related to the use of poliovirus and D2C7 in the treatment of glioblastoma. J.H.S. is an inventor on patents related to PEP-CMV DC vaccine with tetanus, as well as poliovirus vaccine and D2C7 in the treatment of glioblastoma.

Figures

Figure 1:
Figure 1:
Several steps are required for the initiation and maintenance of brain metastasis of lung cancer, breast cancer, melanoma, and renal cell cancer. Molecules involved at each step are indicated.
Figure 2:
Figure 2:
Intercellular crosstalk between tumor cells, astrocytes, microglia and macrophages in the brain parenchyma regulates metastatic outgrowth. Signalling pathways in each interaction are indicated.
See this image and copyright information in PMC

References

    1. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep 2012;14(1):48–54 doi 10.1007/s11912-011-0203-y. - DOI - PubMed
    1. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 2010;77(3):655–61 doi 10.1016/j.ijrobp.2009.08.025. - DOI - PubMed
    1. Society AC. Cancer Statistics Center. Volume 2018. American Cancer Society; 2018. p 17.
    1. Olson EM, Abdel-Rasoul M, Maly J, Wu CS, Lin NU, Shapiro CL. Incidence and risk of central nervous system metastases as site of first recurrence in patients with HER2-positive breast cancer treated with adjuvant trastuzumab. Ann Oncol 2013;24(6):1526–33 doi 10.1093/annonc/mdt036. - DOI - PMC - PubMed
    1. Brastianos PK, Carter SL, Santagata S, Cahill DP, Taylor-Weiner A, Jones RT, et al. Genomic Characterization of Brain Metastases Reveals Branched Evolution and Potential Therapeutic Targets. Cancer Discov 2015;5(11):1164–77 doi 10.1158/2159-8290.cd-15-0369. - DOI - PMC - PubMed

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