Aside from radiation, what is your approach to patients with EGFR-mutated or ALK-translocated metastatic NSCLC who have systemic disease control but fail in the CNS?

While there are systemic agents that have brain penetration, my most standard treatment remains radiotherapy. That said, the questions specifically asked about non-XRT options.

I do think about parenchymal brain metastases and LMD a bit differently. For LMD in EGFR-mutated NSCLC, I do sometimes use erlotinib 600 mg Q4D and have had some success with this approach, although I would not call it standard. For parenchymal brain mets in the EGFR-mutated patient, there were two agents shown at ASCO to...

I agree with Dr. @Dr. First Last that a discussion with my Radiation Oncology colleagues for considering radiotherapy of some form will typically be my first, second, and third choice in this setting. This question is asking about systemic therapy choices for patients with EGFR and ALK mutant NSCLC who have intracranial patterns of failure.

I have written on this topic previously [https://www.themednet.org/question/19254].

The only addendum I will make to my prior comments is that for EGFR mutant...