Molecular drivers in CNS metastatic disease.

The incidence and prevalence of CNS metastases of systemic cancer is only increasing worldwide, especially as our available systemic therapies have improved, resulting in longer survival and more time to allow for CNS progression. Fortunately, we have made substantial therapeutic advances in drug development in the last decade, with newer agents demonstrating significant penetration into the nervous system and notable efficacy. Treatments specifically targeted for certain mutations in the cancer pathway have been especially successful in aborting the onward trajectory and growth of cancer cells in the nervous system. In this review, we provide an overview and update of the drugs that have demonstrated benefit in achieving intracranial control (at times including leptomeningeal disease), many of which have already received or are pending regulatory approval. We also provide a brief look into the landscape of ongoing clinical research including challenges in the field.