Abstract
Simple SummaryThe development of brain metastases, or intracranial metastatic disease (IMD), is a serious and life-altering complication for many patients with cancer. While there have been substantial advancements in the treatments available for IMD and in our understanding of its pathogenesis, conventional methods remain insufficient to detect IMD at an early stage. In this review, we discuss current research on biomarkers specific to IMD. In particular, we highlight biomarkers that can be easily accessed via the bloodstream or cerebrospinal fluid, including circulating tumor cells and DNA, as well as advanced imaging techniques. The continued development of these assays could enable clinicians to detect IMD prior to the development of IMD-associated symptoms and ultimately improve patient prognosis and survival.Nearly 30% of patients with cancer will develop intracranial metastatic disease (IMD), and more than half of these patients will die within a few months following their diagnosis. In light of the profound effect of IMD on survival and quality of life, there is significant interest in identifying biomarkers that could facilitate the early detection of IMD or identify patients with cancer who are at high IMD risk. In this review, we will highlight early efforts to identify biomarkers of IMD and consider avenues for future investigation.
Highlights
The Burden of Intracranial Metastatic DiseaseIntracranial metastatic disease (IMD) is a common complication of many primary cancers [1]
Given our advancing understanding of the molecular drivers and markers involved in the disease progression of non-small cell lung cancer (NSCLC), breast cancer, and melanoma, and their predilection to metastasize to the brain, there is an increasing interest in uncovering biomarkers specific for the development of intracranial metastatic disease (IMD) in these three primary cancers
Though not yet validated in large population-based studies, these results suggest that the detection of IMD in breast cancer patients without surveillance imaging or biopsy may be feasible
Summary
Intracranial metastatic disease (IMD) is a common complication of many primary cancers [1]. 30% of patients with systemic malignancies with growing prevalence due to several factors, including prolonged survival, improved surveillance, and increasing population age [1]. Incidence rates may be even higher in patients with certain primary cancers, most notably non-small cell lung cancer (NSCLC), breast cancer, and melanoma, which account for 45%, 15%, and 10% of IMD in some studies [2,3,4]. Conventional treatment options for IMD include surgical resection, stereotactic radiosurgery (SRS), and whole brain radiation therapy (WBRT) [6]. IMD, prognostic classification systems based on age, performance status, and extracranial and intracranial disease burden have been developed [7,8]. IMD secondary to NSCLC, breast cancer, and melanoma [9,10]
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