Abstract
Primary malignancies of the lung, skin (melanoma), and breast have higher propensity for metastatic spread to the brain. Advances in molecular tumour profiling have aided the development of targeted therapies, stereotactic radiotherapy, and immunotherapy, which have led to some improvement in patient outcomes; however, the overall prognosis remains poor. Continued research to identify new prognostic and predictive biomarkers is necessary to further impact patient outcomes, as this will enable better risk stratification at the point of primary cancer diagnosis, earlier detection of metastatic deposits (for example, through surveillance), and more effective systemic treatments. Brain metastases exhibit considerable inter- and intratumoural heterogeneity—apart from distinct histology, treatment history and other clinical factors, the metastatic brain tumour microenvironment is incredibly variable both in terms of subclonal diversity and cellular composition. This review discusses emerging biomarkers; specifically, the biological context and potential clinical utility of tumour tissue biomarkers, circulating tumour cells, extracellular vesicles, and circulating tumour DNA.
Highlights
Brain cancers can be primary, arising within different areas of the brain, or metastatic, arising from different organs of the body and spreading to the brain, known as brain metastasis (BrM)
BrM patients are still likely to benefit from a droplet digital PCR (ddPCR)-based cell-free DNA (cfDNA) test being implemented, even if it is on the basis of extracranial monitoring data
Investment should be primarily focused on the development of superior biomarkers for early stage cancer that help prevent BrM in more patients and reduce overall rates of distant relapse, companion diagnostics that accurately predict the response to individual therapies
Summary
Brain cancers can be primary, arising within different areas of the brain, or metastatic, arising from different organs of the body and spreading to the brain, known as brain metastasis (BrM). This review focuses on discussing BrM-related biomarkers These metastatic tumours are most frequent in lung cancers, followed by breast, melanoma, colon, kidney, and ovarian cancers, and 15% of cases with unknown primary origin [1]. The systemic therapy regimen usually depends on the primary tumour, for instance, BrM patients with breast primaries are treated with breast cancer regimen on the basis of the breast cancer subtype, lung BrM patients are given lung cancer regimens, and so on Overall, systemic therapy such as chemotherapeutics such as cisplatin, paclitaxel, and temozolomide have shown mixed results in clinical trials [12,13]; they are still used in practice if they can help stabilize extracranial metastases and they may have an impact in the brain in some patients. 3 of biomarkers, highlighting the most recent advances in both pre-clinical and clinical s tings
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