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Feb 19, 2020

Consensus or Controversy? The Integration of Novel Therapies into the Interdisciplinary Management of Non-Small Cell Lung Cancer with CNS Metastases: Our most recent one-on-one interview with Dr Riely as a supplement to a CME symposium held during the 24th Annual Meeting and Education Day of the Society for Neuro-Oncology featuring expert comments on the application of emerging research to patient care.

  • Improved treatment outcomes and impact on the incidence of brain metastases in patients with non-small cell lung cancer (NSCLC) (00:00)
  • Case (Dr Gubens): A man in his mid-50s with adenocarcinoma of the lung with an EGFR exon 19 deletion mutation, asymptomatic brain lesions and significant systemic burden (03:43)
  • Clinical care of patients with NSCLC brain metastases alone and no systemic disease (06:23)
  • Diagnosis of radiation necrosis (11:42)
  • Activity of the third-generation EGFR tyrosine kinase inhibitor (TKI) osimertinib in patients with NSCLC and CNS metastases (13:17)
  • Mechanism of action of osimertinib in the brain and effect on CNS disease progression (15:43)
  • Risks of whole-brain radiation therapy; role of hippocampus sparing and memantine administration in minimizing the adverse effects of whole-brain radiation therapy (17:42)
  • Comparison of survival outcomes with stereotactic radiation therapy and EGFR TKIs (22:24)
  • Case (Dr Gubens): A man in his late 40s with metastatic NSCLC with an ALK rearrangement and large asymptomatic brain metastases (24:46)
  • Role of other TKIs (ie, BRAF, MET, HER2 inhibitors) in NSCLC with CNS metastases (28:15)
  • Antitumor effect of ALK inhibitors in patients with CNS metastases (31:58)
  • Practical issues in the management of CNS metastases: edema, symptomatic CNS metastases and oligoprogression (33:21)
  • Managing CNS metastases with leptomeningeal involvement (36:44)
  • Case (Dr Gubens): A man in his early 40s with metastatic adenocarcinoma of the lung with an EGFR L858R mutation responds to first-line osimertinib for 2 years but then develops 2 new asymptomatic punctate parenchymal metastases and extensive leptomeningeal involvement (39:01)
  • Symptoms of CNS metastases with leptomeningeal involvement; challenges in diagnosis (43:13)
  • Case (Dr Gubens): A woman in her late 60s with metastatic adenocarcinoma of the lung, no targetable tumor mutations and a PD-L1 tumor proportion score (TPS) of 80% (44:53)
  • Outlook on the use of TKIs for patients with CNS metastases (48:42)
  • Potential for combining TKIs with chemotherapy in the management of CNS metastases (50:19)
  • Activity and safety of EGFR TKIs in combination with anti-PD-1/PD-L1 antibodies (52:14)

CME information and select publications