Lung cancer is one of the most lethal diseases in the USA. Approximately 20% of these patients present with brain metastases (BMs). Surgical resection, stereotactic radiosurgery, and whole-brain radiation therapy have historically been the primary treatment modalities for patients with non–small-cell lung cancer (NSCLC) and BMs.More recently, immune checkpoint inhibitors have changed the treatment landscape for many patients with NSCLC; however, the role of immunotherapy in patients with BMs is the subject of ongoing investigations. Here we have reviewed current data and our approach to patients with NSCLC and BMs.

Unfortunately, approximately 57% of patients with non–small-cell lung cancer (NSCLC) present with metastatic disease, and 20% present with brain metastases (BMs) at the time of diagnosis.1,2 During the course of the disease, approximately 25% to 50% of patients will develop BMs. A common surveillance is magnetic resonance imaging scans of the brain once every 3 months. The role of WBRT is declining because of the increased concerns about the potential long-term neurocognitive effects, and a phase III trial revealed limited clinical benefit compared with best supportive care.

Management of brain metastasis is very important and as reviewed in this article things need to be on track to make the best of management.