title: [Systemic treatment of brain metastases from lung cancer].
abstract: Systemic treatment of lung cancer patients with brain metastases is based on clinical (presence of symptomatic intracranial lesions), pathological and molecular characteristics of the disease. The efficacy of standard platinum-based chemotherapy is comparable inside and outside the brain, justifying its use as front-line therapy. The intracranial efficacy of targeted therapies (EGFR tyrosine kinase inhibitors, ALK inhibitors) is demonstrated, and is globally superior to the efficacy of standard chemotherapy, justifying their use as front-line therapy in case of EGFR activating mutation or ALK rearrangement (providing the change in the crizotinib label in France). The concomitant use of whole brain radiotherapy and a systemic treatment (chemotherapy or targeted therapy) is not recommended in the absence of a demonstrated better efficacy and/or acceptable safety profile. Several trials are ongoing to assess new whole brain radiotherapy modalities, new targeted therapies alone or in combination, especially exploring immunotherapy.
authors: Service d'oncologie multidisciplinaire et d'innovations thérapeutiques, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 20, France; Université Aix-Marseille, boulevard Charles-Livon, 13007 Marseille, France; Groupe de recherche sur la prise en charge des métastases cérébrales (GRPCMac), 13273 Marseille, France. Electronic address: fabrice.barlesi@ap-hm.fr.
authors: F
authors: F
authors: Barlesi
authors: Groupe de recherche sur la prise en charge des métastases cérébrales (GRPCMac), 13273 Marseille, France; Département d'oncologie médicale, groupe hospitalier de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors: J-P
authors: JP
authors: Spano
authors: Service de pneumologie et d'oncologie thoracique, CHRU de Lille, 59037 Lille, France.
authors: A B
authors: AB
authors: Cortot
authors: Service de neurologie, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93000 Bobigny, France.
authors: A F
authors: AF
authors: Carpentier
authors: Institut de cancérologie et hématologie, CHRU Morvan, 2, avenue Foch, 29609 Brest cedex, France.
authors: G
authors: G
authors: Robinet
authors: Institut de cancérologie Gustave-Roussy, cancer campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud, 5, rue Jean-Baptiste-Clément, 92296 Châtenay-Malabry cedex, France.
authors: B
authors: B
authors: Besse
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy; D002277:Carcinoma / Q000556:secondary* / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000628:therapy; D018288:Carcinoma, Small Cell / Q000556:secondary / Q000628:therapy; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D006801:Humans; D007167:Immunotherapy; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy; D058990:Molecular Targeted Therapy; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D016634:Radiosurgery
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors
keywords: Afatinib; Ceritinib; Chemotherapy; Chimiothérapie; Cisplatin; Cisplatine; Crizotinib; Céritinib; Erlotinib; Gefitinib; Géfitinib; Radiothérapie pancérébrale; Whole brain radiotherapy