Initial management of brain metastases from ALK-positive NSCLC

For patients who are frail or prefer to avoid aggressive treatment, supportive care alone is an alternative option.

This algorithm applies to NSCLC with the novel fusion oncogene EML4-ALK.

ALK: anaplastic lymphoma kinase; NSCLC: non-small cell lung cancer; SRS: stereotactic radiosurgery; WBRT: whole-brain radiotherapy.

* For patients with a solitary brain metastasis, surgical resection may improve survival and may be an alternative option. Refer to the UpToDate discussion on oligometastatic disease and brain metastases.

¶ SRS is preferred over WBRT, when feasible. SRS versus WBRT is discussed in detail in the UpToDate overview discussion on treatment of brain metastases.

For select patients, systemic therapy alone with a different brain-penetrable ALK inhibitor may be an alternative to radiation, particularly if they have only 1 or 2 metastases and are asymptomatic. Decisions should be based on availability of agents and patient preference.

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Initial management of brain metastases from ALK-positive NSCLC