{"entity":{"id":"brain-metastases","kind":"term","name":"Brain metastases (intracranial disease)","aka":["brain metastasis","intracranial","intracranial metastases","CNS metastases","CNS disease","CNS activity","intracranial response","intracranial ORR","CNS relapse","brain mets","intracranial responses"],"tldr":"Tumour deposits that have travelled to the brain from a cancer elsewhere, ten times more common than cancers that start in the brain, mostly from lung, breast, melanoma and kidney cancer. Because the blood-brain barrier excludes most drugs, whether a medicine reaches and shrinks them now decides which drug is chosen, and trials report intracranial progression separately.","summary":"Lung cancer, breast cancer (especially HER2-positive and triple-negative), melanoma and kidney cancer account for most cases; 30-50% of driver-positive lung cancer patients develop them. Local treatment is stereotactic radiosurgery or surgery for limited disease and whole-brain radiotherapy for extensive disease. Because the blood-brain barrier excludes many drugs, CNS penetration and intracranial response rates (osimertinib, lorlatinib, tucatinib, T-DXd in DESTINY-Breast12) increasingly determine which drug is chosen, and trials now report intracranial progression-free survival separately.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Brain_metastasis","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Brain_metastasis"},{"label":"Brown et al., radiosurgery alone versus radiosurgery with whole-brain radiotherapy for 1 to 3 brain metastases (JAMA 2016)","url":"https://doi.org/10.1001/jama.2016.9839"},{"label":"Triple Negative Breast Cancer Foundation: living with metastatic TNBC","url":"https://tnbcfoundation.org/living-with-tnbc/living-with-metastatic-tnbc"},{"label":"Cancer Research UK: symptoms of metastatic lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/metastatic/symptoms"},{"label":"NICE NG122: lung cancer, palliative interventions and supportive and palliative care","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"}],"tags":[],"related":["stereotactic-radiosurgery","wbrt","cns-penetration","leptomeningeal-disease"],"cancers":["nsclc","breast-her2-positive","tnbc","melanoma","secondary-brain-tumours","lung-cancer","sclc"],"sections":["radiation"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Triple-negative breast cancer spreads to the brain more often than other breast subtypes (the cancer record puts it at up to 30 to 45% of metastatic disease). For 1 to 3 metastases, a randomised trial (Brown 2016) found radiosurgery alone caused less cognitive decline at 3 months than radiosurgery plus whole-brain radiotherapy with no difference in survival, and suggested radiosurgery alone as the preferred strategy where the metastases are suitable.","Lung cancer: Cancer Research UK says cancer that has spread to the brain might cause memory problems, mood or personality changes, seizures, confusion, severe headaches often with sickness, or weakness of an arm or leg. NICE NG122 (1.16.1) says to offer dexamethasone to people with symptomatic brain metastases and to reduce to the minimum necessary maintenance dose for symptomatic response, and (1.16.2) points to the management of confirmed brain metastases in its brain tumours guideline for the treatment itself."],"category":"Anatomy"},"route":"/terms/brain-metastases/","neighbours":{"term":[{"id":"cns-penetration","kind":"term","name":"CNS penetration (brain-penetrant drugs)","route":"/terms/cns-penetration/"},{"id":"graded-prognostic-assessment","kind":"term","name":"Graded Prognostic Assessment (GPA) for brain metastases","route":"/terms/graded-prognostic-assessment/"},{"id":"leptomeningeal-disease","kind":"term","name":"Leptomeningeal disease","route":"/terms/leptomeningeal-disease/"},{"id":"tnbc-symptom-control-palliation","kind":"term","name":"Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life","route":"/terms/tnbc-symptom-control-palliation/"},{"id":"lung-palliation-breathlessness-effusion-obstruction","kind":"term","name":"Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain","route":"/terms/lung-palliation-breathlessness-effusion-obstruction/"},{"id":"pci-term","kind":"term","name":"Prophylactic cranial irradiation (PCI)","route":"/terms/pci-term/"},{"id":"stereotactic-radiosurgery","kind":"term","name":"Stereotactic radiosurgery (SRS)","route":"/terms/stereotactic-radiosurgery/"},{"id":"wbrt","kind":"term","name":"Whole-brain radiotherapy (WBRT)","route":"/terms/wbrt/"}],"cancer":[{"id":"advanced-melanoma","kind":"cancer","name":"Advanced melanoma (unresectable stage III and stage IV)","route":"/cancers/advanced-melanoma/"},{"id":"alk-positive-nsclc","kind":"cancer","name":"ALK-positive non-small-cell lung cancer","route":"/cancers/alk-positive-nsclc/"},{"id":"secondary-brain-tumours","kind":"cancer","name":"Brain metastases (secondary brain tumours)","route":"/cancers/secondary-brain-tumours/"},{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"egfr-mutant-nsclc","kind":"cancer","name":"EGFR-mutated non-small-cell lung cancer","route":"/cancers/egfr-mutant-nsclc/"},{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"her2-mutant-nsclc","kind":"cancer","name":"HER2-mutant non-small-cell lung cancer","route":"/cancers/her2-mutant-nsclc/"},{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"her2-positive-breast-brain-metastases","kind":"cancer","name":"HER2-positive breast cancer with brain metastases","route":"/cancers/her2-positive-breast-brain-metastases/"},{"id":"kras-g12c-nsclc","kind":"cancer","name":"KRAS G12C-mutant non-small-cell lung cancer","route":"/cancers/kras-g12c-nsclc/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"metastatic-cancer","kind":"cancer","name":"Metastatic cancer (cancer that has spread)","route":"/cancers/metastatic-cancer/"},{"id":"tnbc-metastatic","kind":"cancer","name":"Metastatic triple-negative breast cancer","route":"/cancers/tnbc-metastatic/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"ntrk-fusion-nsclc","kind":"cancer","name":"NTRK fusion-positive non-small-cell lung cancer","route":"/cancers/ntrk-fusion-nsclc/"},{"id":"ret-fusion-nsclc","kind":"cancer","name":"RET fusion-positive non-small-cell lung cancer","route":"/cancers/ret-fusion-nsclc/"},{"id":"ros1-positive-nsclc","kind":"cancer","name":"ROS1-positive non-small-cell lung cancer","route":"/cancers/ros1-positive-nsclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"paper":[{"id":"paper-wu-alina-adjuvant-alectinib-nejm-2024","kind":"paper","name":"Alectinib in resected ALK-positive non-small-cell lung cancer","route":"/key-papers/paper-wu-alina-adjuvant-alectinib-nejm-2024/"},{"id":"paper-peters-alex-alectinib-crizotinib-nejm-2017","kind":"paper","name":"Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer","route":"/key-papers/paper-peters-alex-alectinib-crizotinib-nejm-2017/"},{"id":"paper-kwak-crizotinib-alk-nsclc-nejm-2010","kind":"paper","name":"Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer","route":"/key-papers/paper-kwak-crizotinib-alk-nsclc-nejm-2010/"},{"id":"paper-marcoux-egfr-small-cell-transformation-outcomes-jco-2019","kind":"paper","name":"EGFR-mutant adenocarcinomas that transform to small-cell lung cancer and other neuroendocrine carcinomas: clinical outcomes","route":"/key-papers/paper-marcoux-egfr-small-cell-transformation-outcomes-jco-2019/"},{"id":"paper-shaw-crown-lorlatinib-crizotinib-nejm-2020","kind":"paper","name":"First-line lorlatinib or crizotinib in advanced ALK-positive lung cancer","route":"/key-papers/paper-shaw-crown-lorlatinib-crizotinib-nejm-2020/"},{"id":"paper-sandler-ecog-4599-bevacizumab-nsclc-nejm-2006","kind":"paper","name":"Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer","route":"/key-papers/paper-sandler-ecog-4599-bevacizumab-nsclc-nejm-2006/"},{"id":"paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999","kind":"paper","name":"Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission","route":"/key-papers/paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999/"},{"id":"paper-lin-tnbc-cns-metastases-dfci-cancer-2008","kind":"paper","name":"Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases","route":"/key-papers/paper-lin-tnbc-cns-metastases-dfci-cancer-2008/"}],"roadmap":[{"id":"tnbc-roadmap","kind":"roadmap","name":"Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem","route":"/roadmaps/tnbc-roadmap/"}],"idea":[{"id":"idea-lung-brain-metastasis-prevention-as-a-primary-endpoint","kind":"idea","name":"Measure brain metastasis prevention as a primary endpoint, not as a secondary one","route":"/ideas/idea-lung-brain-metastasis-prevention-as-a-primary-endpoint/"},{"id":"idea-tnbc-brain-metastasis-trials","kind":"idea","name":"Trials that include, and report, brain metastases in triple-negative breast cancer","route":"/ideas/idea-tnbc-brain-metastasis-trials/"}],"trial":[{"id":"alesia","kind":"trial","name":"ALESIA","route":"/trials/alesia/"},{"id":"alex","kind":"trial","name":"ALEX","route":"/trials/alex/"},{"id":"alta","kind":"trial","name":"ALTA","route":"/trials/alta/"},{"id":"alta-1l","kind":"trial","name":"ALTA-1L","route":"/trials/alta-1l/"},{"id":"nct01774721","kind":"trial","name":"ARCHER 1050","route":"/trials/nct01774721/"},{"id":"nct01828099","kind":"trial","name":"ASCEND-4","route":"/trials/nct01828099/"},{"id":"aura3","kind":"trial","name":"AURA3","route":"/trials/aura3/"},{"id":"nct06793332","kind":"trial","name":"BrAin Metastasis in tripLe Negateive Breast Cancer: IvoneScimab and Trop2 ADC","route":"/trials/nct06793332/"},{"id":"checkmate-204","kind":"trial","name":"CheckMate 204","route":"/trials/checkmate-204/"},{"id":"nct06176261","kind":"trial","name":"DATO-BASE: DATOpotamab-deruxtecan for Breast Cancer Brain metAstaSEs","route":"/trials/nct06176261/"},{"id":"nct02767804","kind":"trial","name":"eXalt3","route":"/trials/nct02767804/"},{"id":"j-alex","kind":"trial","name":"J-ALEX","route":"/trials/j-alex/"},{"id":"nct06586866","kind":"trial","name":"JK-1201I in Triple Negative Breast Cancer Patients with Brain Metastases","route":"/trials/nct06586866/"},{"id":"jrosg-99-1","kind":"trial","name":"JROSG 99-1 (Aoyama): stereotactic radiosurgery with or without whole-brain radiotherapy","route":"/trials/jrosg-99-1/"},{"id":"nct05866432","kind":"trial","name":"Phase II Study of Dato-DXd in Triple-negative Breast Cancer Patients With Newly Diagnosed or Progressing Brain Metastases","route":"/trials/nct05866432/"},{"id":"pci-overview-1999","kind":"trial","name":"Prophylactic Cranial Irradiation Overview (Auperin meta-analysis)","route":"/trials/pci-overview-1999/"},{"id":"nct07623577","kind":"trial","name":"Sac-TMT Combined With Bevacizumab in TNBC With Brain Metastases","route":"/trials/nct07623577/"},{"id":"nct07458113","kind":"trial","name":"Sac-TMT for Active TNBC Brain Metastases","route":"/trials/nct07458113/"},{"id":"nct06238921","kind":"trial","name":"Sacituzumab Govitecan and Zimberelimab w/SRS in the Management of Metastatic Triple Negative Breast Cancer With Brain Metastases","route":"/trials/nct06238921/"},{"id":"nct07638852","kind":"trial","name":"Study of Radiotherapy Combined With Cisplatin/Carboplatin, Adebrelimab and Bevacizumab in the Treatment of TNBC-BM.","route":"/trials/nct07638852/"}],"technology":[{"id":"in-room-imaging-systems","kind":"technology","name":"In-room imaging for radiotherapy (cone-beam CT, ExacTrac, CT-on-rails, HyperSight)","route":"/technologies/in-room-imaging-systems/"},{"id":"litt-systems","kind":"technology","name":"Laser interstitial thermal therapy systems (NeuroBlate, Visualase)","route":"/technologies/litt-systems/"},{"id":"patient-positioning-surface-guidance-systems","kind":"technology","name":"Patient positioning and surface guidance systems (AlignRT, Catalyst, ExacTrac Dynamic)","route":"/technologies/patient-positioning-surface-guidance-systems/"},{"id":"transcranial-focused-ultrasound-systems","kind":"technology","name":"Transcranial focused ultrasound systems (Exablate Neuro, SonoCloud)","route":"/technologies/transcranial-focused-ultrasound-systems/"}],"company":[{"id":"carthera","kind":"company","name":"Carthera","route":"/companies/carthera/"}]}}