Treatment
Recommendation 2.1
➤ Patients with symptomatic brain metastases should be offered
local therapy (radiosurgery/radiation therapy and/or surgery) as
recommended in this guideline regardless of the systemic therapy used
for the systemic disease. (Strong recommendation; EB-H)
Recommendation 2.2
➤ For patients with asymptomatic brain metastases, local therapy
should not be deferred unless deferral is specifically recommended in
Recommendations 2.3 through 2.7 of this guideline. The decision to
defer local therapy should be based on a multi-disciplinary discussion
(neuro or medical oncology, neurosurgery, and radiation oncology) of
the potential benefits and harms the patient may experience. (Strong
recommendation; EB-H)
Recommendation 2.3
➤ Osimertinib or icotinib may be offered to patients with asymptomatic
brain metastases from EGFR-mutant NSCLC. If these agents are used,
local therapy may be delayed until there is evidence of intracranial
progression. (Weak recommendation; IC-L)
Qualifying Statement: The expert panel recognizes that as of this publication, icotinib is
not approved by the US Food & Drug Administration (FDA) or the European Medicines
Agency.
Recommendation 2.4
➤ Alectinib, brigatinib, or ceritinib may be offered to patients with
asymptomatic brain metastases from ALK-rearranged NSCLC. If these
agents are used, local therapy may be delayed until there is evidence of
intracranial progression. (Weak recommendation; IC-L)
Recommendation 2.5
➤ Pembrolizumab may be offered to patients with asymptomatic brain
metastases from immunotherapy-naive PD-L1 expressing NSCLC
who are also receiving pemetrexed and a platinum agent. (Weak
recommendation; IC-L)
Note: See Recommendation 2.2 regarding local therapy.
