Management of brain metastases in non-small cell lung cancer

The majority of brain metastases result from non-small cell lung cancer. They are globally of poor prognosis. The objective of the present article is to review the various available treatment approaches for brain metastases from non-small cell lung cancer and how to articulate them. Treatment strategies include the medical management of symptoms and control of brain metastases. Classical whole brain irradiation and local treatments such as surgery and radiosurgery may improve survival for patients with a low number of brain metastases and controlled extracranial disease. Systemic treatments may also be active. Several studies show interesting response rates to chemotherapy for brain metastases. Anti-epidermal growth factor receptor therapies are effective in brain metastases, especially in epidermal growth factor receptor-mutated patients. Recent data suggest that the use of antiangiogenic agents (bevacizumab) is safe in selected brain metastases. Multimodality management of brain metastasis from non-small cell lung cancer is probably the best way to manage patients, but the best sequence of these treatments is still not established.