Brain metastases (secondary brain tumours): lines of therapy
7 standard-of-care settings across 2 lines and 5 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Fit | Single large or symptomatic lesion, fit patient | Surgical resection followed by radiosurgery to the cavity (N107C) rather than whole-brain radiotherapy. | NCCN Guidelines: Central Nervous System Cancers | 32 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Symptomatic oedema | Dexamethasone, tapered as quickly as symptoms allow; anticonvulsants only after a seizure. | NCCN Guidelines: Central Nervous System Cancers | 70 | |
| All comers | Limited number of metastases | Stereotactic radiosurgery alone (Alliance N0574); whole-brain radiotherapy withheld because it worsens cognition without lengthening life. | NCCN Guidelines: Central Nervous System Cancers | 65 | |
| All comers | Melanoma | Nivolumab plus ipilimumab for asymptomatic metastases (CheckMate 204); dabrafenib plus trametinib for BRAF V600-mutant disease (COMBI-MB); radiosurgery for symptomatic or progressing lesions. | NCCN Guidelines: Central Nervous System Cancers | 88 | |
| HER2 | HER2-positive breast cancer | Tucatinib with trastuzumab and capecitabine (HER2CLIMB) or trastuzumab deruxtecan (DESTINY-Breast12), with local therapy for symptomatic lesions. | NCCN Guidelines: Central Nervous System Cancers | 97 | |
| HR-positive | Driver-positive lung cancer, asymptomatic metastases | Brain-penetrant targeted therapy first: osimertinib (EGFR), lorlatinib or alectinib (ALK); radiosurgery for progression. | NCCN Guidelines: Central Nervous System Cancers | 87 | |
| KMT2A | Many metastases or leptomeningeal spread | Hippocampal-avoidance whole-brain radiotherapy with memantine (NRG CC001) where whole-brain treatment is chosen; radiosurgery to many lesions in selected patients; best supportive care alone in poor-prognosis lung cancer (QUARTZ). | NCCN Guidelines: Central Nervous System Cancers | 93 |
Sequence and caution pairings
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.