Dr. Goldberg on Managing CNS Metastases in Oncogene-Driven NSCLC

Sarah B. Goldberg, MD, MPH
Published: Wednesday, Feb 20, 2019



Sarah B. Goldberg, MD, MPH, an assistant professor of medicine at the Yale School of Medicine and Yale Cancer Center, discusses strategies for managing central nervous system (CNS) metastases in patients with oncogene-driven non–small cell lung cancer (NSCLC).

For patients with EGFR and ALK mutations, the treatment paradigm is a little more defined than for patients with rare alterations like BRAF, ROS1, and MET. However, researchers are starting to see promising CNS activity with targeted therapies for these mutations. For example, for patients with BRAF mutations, oncologists have been using dabrafenib (Tafinlar) and trametinib (Mekinist). Goldberg says she has not yet seen CNS activity with these agents in NSCLC, but the drugs have demonstrated promising intracranial responses in patients with melanoma. For that reason, these BRAF inhibitors should be considered as a potentially viable option.

In patients with other alterations such as ROS1 and MET, recent studies have shown benefit with the newer-generation targeted drugs. However, more data will be needed to confidently use these drugs for those with CNS metastases; this will become a critical endpoint moving forward, Goldberg concludes.
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Sarah B. Goldberg, MD, MPH, an assistant professor of medicine at the Yale School of Medicine and Yale Cancer Center, discusses strategies for managing central nervous system (CNS) metastases in patients with oncogene-driven non–small cell lung cancer (NSCLC).

For patients with EGFR and ALK mutations, the treatment paradigm is a little more defined than for patients with rare alterations like BRAF, ROS1, and MET. However, researchers are starting to see promising CNS activity with targeted therapies for these mutations. For example, for patients with BRAF mutations, oncologists have been using dabrafenib (Tafinlar) and trametinib (Mekinist). Goldberg says she has not yet seen CNS activity with these agents in NSCLC, but the drugs have demonstrated promising intracranial responses in patients with melanoma. For that reason, these BRAF inhibitors should be considered as a potentially viable option.

In patients with other alterations such as ROS1 and MET, recent studies have shown benefit with the newer-generation targeted drugs. However, more data will be needed to confidently use these drugs for those with CNS metastases; this will become a critical endpoint moving forward, Goldberg concludes.



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