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 24^th 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