From the Guidelines
Lung cancer, breast cancer, and melanoma are the most common sources of suprasellar and pontine metastases, with lung cancer being the most prevalent, accounting for a significant portion of brain metastases overall. These cancers have a tendency to spread hematogenously to the brain, with the suprasellar region and pons being susceptible areas due to their rich vascular supply 1. The symptoms of metastases to these regions vary based on their location - suprasellar lesions may cause:
- Visual field defects
- Pituitary dysfunction
- Diabetes insipidus while pontine metastases typically manifest with:
- Cranial nerve palsies
- Long tract signs
- Cerebellar symptoms The diagnosis is usually confirmed through contrast-enhanced MRI, which shows enhancing lesions with surrounding edema. Treatment approaches include:
- Stereotactic radiosurgery
- Whole-brain radiation therapy
- Surgical resection when feasible
- Systemic therapies depending on the primary cancer type, as discussed in the context of radiotherapy in preclinical models of brain metastases 1. The prognosis for patients with brain metastases to these regions remains poor, with median survival typically measured in months, though targeted therapies and immunotherapies have improved outcomes for specific cancer types, as seen in recent years with the application of targeted therapy and immunotherapy leading to improvements in survival 1.
From the FDA Drug Label
Fifty-four percent (54%) of patients had extra-thoracic visceral metastases, including 34% with central nervous system (CNS) metastases The most common sites of CNS metastasis are not specified in the provided drug label.
- Key sites of metastasis are not directly mentioned in the label.
- Suprasellar and pontine metastasis are not explicitly stated as the most common sites. 2
From the Research
Brain Metastasis Locations
- The provided studies do not specifically mention the most common locations of suprasellar and pontine metastasis in non-small cell lung cancer (NSCLC) patients 3, 4, 5, 6, 7.
- However, it is known that brain metastases can occur in various locations, including the cerebral hemispheres, cerebellum, and brainstem 4, 6.
Management of Brain Metastases
- The management of brain metastases in NSCLC patients has evolved over time, with a shift from whole-brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) alone for patients with limited brain metastases 3, 4, 6.
- The use of targeted therapies, such as tyrosine kinase inhibitors, has also improved the management of brain metastases in NSCLC patients, particularly those with targetable mutations 5, 6, 7.
- The combination of SRS and systemic therapies has been shown to improve survival in patients with NSCLC brain metastases, particularly those with targetable mutations 7.