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Pellerino et al. J Cancer Metastasis Treat 2020;6:41 I http://dx.doi.org/10.20517/2394-4722.2020.80 Page 15 of 20

patients with equivocal MRI findings, but sensitivity and specificity of different liquid biopsy techniques
have to be compared, and cut-off values should be identified. The third-generation EGFR inhibitor
osimertinib has demonstrated significant CNS penetration and survival advantage in EGFR-mutated LM
compared with standard therapies, such as RT, traditional chemotherapy, first- and second-generation
TKIs. The combination of third-generation TKIs with RT or traditional chemotherapy could provide an
additional advantage in terms of quality of life and disease control. Several case-reports have reported some
efficacy of ALK inhibitors in LM, but clinical trials should be designed to confirm this benefit. For those
patients who do not have druggable mutations, ICIs could represent a therapeutic option with acceptable
tolerability, but clinical trials focused on LM from NSCLC are lacking and represent a research focus for
the future.

DECLARATIONS
Authors’ contributions
Conceptualization, writing original draft and preparation: Pellerino A, Soffietti R, Rudà R
Data collection and curation: Pellerino A, Internò V, Muscolino E, Mo F, Bruno F, Pronello E, Franchino F,
Soffietti R, Rudà R
Writing review and editing: Pellerino A, Internò V, Muscolino E, Mo F, Bruno F, Pronello E, Franchino F

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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