A Need for More Molecular Profiling in Brain Metastases.

Journal Article (Journal Article;Review)

As local disease control improves, the public health impact of brain metastases (BrM) continues to grow. Molecular features are frequently different between primary and metastatic tumors as a result of clonal evolution during neoplasm migration, selective pressures imposed by systemic treatments, and differences in the local microenvironment. However, biomarker information in BrM is not routinely obtained despite emerging evidence of its clinical value. We review evidence of discordance in clinically actionable biomarkers between primary tumors, extracranial metastases, and BrM. Although BrM biopsy/resection imposes clinical risks, these risks must be weighed against the potential benefits of assessing biomarkers in BrM. First, new treatment targets unique to a patient's BrM may be identified. Second, as BrM may occur late in a patient's disease course, resistance to initial targeted therapies and/or loss of previously identified biomarkers can occur by the time of occult BrM, rendering initial and other targeted therapies ineffective. Thus, current biomarker data can inform real-time treatment options. Third, biomarker information in BrM may provide useful prognostic information for patients. Appreciating the importance of biomarker analyses in BrM tissue, including how it may identify specific drivers of BrM, is critical for the development of more effective treatment strategies to improve outcomes for this growing patient population.

Full Text

Duke Authors

Cited Authors

  • Shen, E; Van Swearingen, AED; Price, MJ; Bulsara, K; Verhaak, RGW; Baëta, C; Painter, BD; Reitman, ZJ; Salama, AKS; Clarke, JM; Anders, CK; Fecci, PE; Goodwin, CR; Walsh, KM

Published Date

  • 2021

Published In

Volume / Issue

  • 11 /

Start / End Page

  • 785064 -

PubMed ID

  • 35145903

Pubmed Central ID

  • PMC8821807

International Standard Serial Number (ISSN)

  • 2234-943X

Digital Object Identifier (DOI)

  • 10.3389/fonc.2021.785064


  • eng

Conference Location

  • Switzerland