Management of Central Nervous System Tumors

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Meningiomas represent a full spectrum of tumors that are the most common type of brain tumor in adults. Although most are benign, recent research has shown that the recurrence rate is high, especially for WHO grades 2 and 3, and overall survival is poor for these grades. Treatment is evolving, and recently sunitinib and bevacizumab have shown promise compared with historical treatments. However, more research is needed to identify better treatments for meningiomas. Treatment of brain metastases is another evolving field. Studies suggest that stereotactic radiosurgery is preferable to whole-brain radiation therapy and that immune checkpoint inhibitors and therapies targeted to the T790M mutation and ALK can improve outcomes in patients with non–small cell lung cancer and brain metastases.

Correspondence: Thomas Kaley, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Email: kaleyt@mskcc.org; and Louis B. Nabors, MD, University of Alabama at Birmingham Comprehensive Cancer Center, 510 20th Street South, FOT 1020, Birmingham, AL 35294. Email: bnabors@uab.edu
  • 1.

    Daras M, Kaley TJ. Benign brain tumors and phakomatoses. Continuum (Minneap Minn) 2015;21:397414.

  • 2.

    Rogers L, Barani I, Chamberlain M, . Meningiomas: knowledge base, treatment outcomes, and uncertainties: a RANO review. J Neurosurg 2015;122:423.

  • 3.

    Kaley T, Barani I, Chamberlain M, . Historical benchmarks for medical therapy trials in surgery- and radiation-refractory meningioma: a RANO review. Neuro Oncol 2014;16:829840.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Kaley T, Wen P, Schiff D, . Phase II trial of sunitinib for recurrent and progressive atypical and anaplastic meningioma. Neuro Oncol 2015;17:116121.

  • 5.

    Nayak L, Iwamoto FM, Rudnick JD . Atypical and anaplastic meningiomas treated with bevacizumab. J Neurooncol 2012;109:187193.

  • 6.

    Brown PD, Jaeckle K, Ballman KV, . Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 2016;316:401409.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Pike LRG, Bang A, Mahal BA, . The impact of radiation therapy on lymphocyte count and survival in metastatic cancer patients receiving PD-1 checkpoint inhibitors. Int J Radiat Oncol Biol Phys 2019;103:142151.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Chen L, Douglass J, Kleinberg L, . Concurrent immune checkpoint inhibitors and stereotactic radiosurgery for brain metastases in non-small cell lung cancer, melanoma, and renal carcinoma. Int J Radiat Oncol Biol Phys 2018;100:916925.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Anderson ES, Postow MA, Wolchok J, . Melanoma brain metastases treated with stereotactic radiosurgery and concurrent pembrolizumab display marked regression; efficacy and safety of combined treatment. J Immunother Cancer 2017;5:76.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Arbour KC, Mezquita L, Long, N, . Impact of baseline steroids on efficacy of programmed cell death-1 and programmed death ligand 1 blockade in patients with non-small cell lung cancer. J Clin Oncol 2018;36:28722878.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Tawbi HA, Forsyth PA, Algazi A, . Combined nivolumab and ipilimumab in melanoma metastatic to the brain. N Engl J Med 2018;379:722730.

  • 12.

    Mok TS, Wu YL, Ahn MJ, . Osimertinib or platinum-pemetrexed in EGFR T790M-positive lung cancer. N Engl J Med 2017;376:629640.

  • 13.

    Peters S, Camidge DR, Shaw AT, . Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med 2017; 377:829838.

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