Treatment of brain metastases in ALK-positive non-small cell lung cancer

Brain metastases are quite frequent in patients with ALK-translocated non-small cell lung cancer (NSCLC): they are often not amenable to surgical resection and are generally treated with radiotherapy (RT). This however causes severe late toxic side effects that may become invalidating considering the relatively long survival provided by recent medical treatment with target therapies. Several clinical trials have demonstrated that ALKinhibitors (crizotinib, alectinib, brigatinib) show excellent activity also against brain metastases. It is therefore reasonable, in asymptomatic patients, to start treatment with specific inhibitors: RT will be used at the time of tumor progression or when symptoms appear. This sequence provides the best quality of life for patients.

Automated summary

Brain metastases are common in patients with ALK-translocated non-small cell lung cancer and are typically treated with radiotherapy. However, this can lead to severe late toxic side effects, prompting the use of ALK inhibitors such as crizotinib, alectinib, and brigatinib which have shown excellent activity against brain metastases. Starting treatment with specific inhibitors in asymptomatic patients and using radiotherapy when needed provides the best quality of life for patients.