Lung cancer brain metastases management at the dawn of personalized medicine: are we ready to break the barriers?
Cet article examine l'évolution de la prise en charge des métastases cérébrales ayant pour origine un cancer du poumon puis identifie les futures orientations concernant la conception d'essais cliniques, en particulier l'intégration dans ces essais d'outils cliniques, biologiques et radiologiques permettant de personnaliser les stratégies thérapeutiques
Brain metastases (BM) occur in nearly half of patients with lung cancer and significantly impair survival and quality of life. Historically, limited blood–brain barrier penetration and low intracranial efficacy of systemic therapies restricted treatment options. However, advances in immune checkpoint inhibitors and next-generation CNS-penetrant targeted therapies have reshaped the therapeutic landscape, improving intracranial control and patient outcomes. In parallel, stereotactic radiotherapy has emerged as a precise and effective local treatment with a more favorable safety profile compared with whole-brain radiotherapy. The integration of systemic and local approaches, guided by personalized medicine, offers new opportunities to optimize central nervous system disease control. Nevertheless, these advances raise key challenges regarding treatment sequencing, patient selection, and risk-adapted strategies. This review summarizes the evolving management of lung cancer BM and highlights future directions for clinical trial design, emphasizing the integration of clinical, biological, and radiological tools to guide individualized treatment strategies.
Annals of Oncology , résumé, 2026