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Molecular-Targeted Agents as a Novel Therapeutic Tool for Brain Metastases Toshihiko IUCHI 1 1Department of Neurosurgery, Chiba Cancer Center Keyword: 転移性脳腫瘍 , EGFR変異 , ALK融合遺伝子 , チロシンキナーゼ阻害薬 , brain metastases , EGFR mutation , ALK fusion gene , tyrosine kinase inhibitors pp.61-72
Published Date 2022/1/10
DOI https://doi.org/10.11477/mf.1436204532
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 Brain metastases(BM)follow the nature of the primary cancer, and understanding the associated genomic abnormalities is essential in the construction of therapeutic strategies for BM. BM showed an excellent response to EGFR-TKI, but the duration of the effect was limited to approximately one year. Despite the longer survival of patients with EGFRm BM, these tumors tended to progress to leptomeningeal carcinomatosis(LMC), and the frequency of central nervous system death was higher than that of tumors without driver mutations. EGFR-TKI also had an effect on LMC and even improved hydrocephalus, but it achieved negative conversion of cancer cells in the cerebrospinal fluid in only limited cases. ALK-TKI also induced a good reduction of BM, and the duration of the response was quite long. Because the expected prognosis of patients after BM in ALK-positive cases is over 5 years, we should choose treatment modalities that are safe in the long term. The dominant cause of death in cancer patients is extracranial progression, and control of extracranial lesions should be prioritized, even in cases with BM. Therefore, the purpose of treatment of BM is to keep patients in a better condition and to maintain the indications for systemic treatment, and molecular-targeted agents, with both the safety and sufficient effectiveness, meet that demand.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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