The rapidly evolving treatment landscape for patients with brain metastases from epidermal growth factor receptor mutated nonsmall cell lung cancer

While this quote is likely apocryphal and not, as is commonly attributed, a curse of Chinese origin (1), its ironic sentiment seems apt when one considers the rapidly shifting treatment landscape for patients with brain metastases. This is particularly true for non-small cell lung cancer, where systemic therapy is now frequently dictated by driver mutation-driven sub-categorization. The “seismic” changes in management for these groups of patients are being driven by the collision of two “tectonic” clinical forces: (I) development of molecularly-targeted, systemic therapies with clinically significant CNS activity; and (II) the shift towards tumour-targeted vs. whole brain radiotherapy (WBRT) [debated in (2,3)]. The resulting upheaval and emergence of a new “treatment geography” in this clinical space has made for “interesting times” indeed