Updated Guidelines on Emerging Therapies for Managing Adults with Metastatic Brain Tumors

The Congress of Neurological Surgeons (CNS) has issued updated guidelines regarding the use of emerging treatment options for adults with metastatic brain tumors. These guidelines reflect advancements in pharmaceuticals, radiation technologies, and surgical equipment, aiming to enhance patient care and outcomes. Dr. Jeffrey J. Olson from Emory University and colleagues published the revised recommendations in the journal Neurosurgery.

The updated guidelines emphasize the rapid progress in both nonsurgical and surgical therapies, enabling clinicians to make more informed treatment decisions. The joint endorsement by the CNS/AANS highlights the significance and credibility of these new standards.

The revisions are based on a comprehensive review of 162 primary studies published between 2016 and 2022. A major focus is on targeted therapies tailored to specific genetic mutations within tumors.

For non–small-cell lung cancer (NSCLC) with brain metastases, for example, the guidelines recommend the use of epidermal growth factor receptor (EGFR) inhibitors like icotinib combined with whole-brain radiation therapy (WBRT) for multiple untreated metastases. For patients with ALK mutations, drugs like alectinib are preferred. When EGFR or ALK status isn't assessed, adding specific tyrosine kinase inhibitors (TKIs) to radiation therapy is advised.

In melanoma brain metastases, for tumors with BRAF V600E mutations, adding dabrafenib and trametinib is recommended, with immunotherapy also indicated for BRAF-altered tumors. Breast cancer patients with HER-2 positivity should receive trastuzumab in combination with stereotactic radiosurgery (SRS), and lapatinib can be added during SRS.

Leptomeningeal metastases are also addressed, suggesting osimertinib for EGFR-mutant NSCLC, alectinib for ALK-positive cases, and intrathecal trastuzumab for HER-2–positive breast cancers. Furthermore, laser interstitial thermal therapy (LITT) is considered an option for recurrent tumors after SRS, individualized by tumor location and patient health.

The guidelines also touch on emerging therapies like immune modulators and radiosensitizers, though evidence remains insufficient for firm recommendations in some areas. Overall, these updates represent a significant step forward in optimizing treatment strategies for metastatic brain tumors.

For more detailed information, reference the original publication: Kristin Huntoon et al, Neurosurgery (2025). Source: medicalxpress.com.