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Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Brain metastases (BM) represent a deleterious complication in many solid tumors. Despite advances in systemic therapy, BM are still associated with significant morbidity and mortality. Consequently, preventive strategies are gaining importance and represent a dynamic area of investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Relevant literature and clinical trials were included, focusing on systemic therapies, multimodal treatment approaches, and future therapeutic avenues. Clinical trials reporting on secondary (preventing BM in a yet BM-free cancer patient) and tertiary prevention (preventing formation of new and recurrence of existent BM in a patient who has already developed BM) were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A number of BM treatment-effective drugs have shown BM-preventive effects: In NSCLC, the EGFR-inhibitor osimertinib and ALK inhibitors like alectinib, brigatinib and lorlatinib lower the incidence of BM. In HER2-positive breast cancer, tucatinib and trastuzumab deruxtecan have preventive activity in patients without BM at baseline. In melanoma, BRAF\/MEK inhibition and immunotherapy might be able to delay the onset of BM, although prospective data remains limited to date. Notably, drugs effective in BM therapy do not necessarily work in BM prevention, and vice versa. Preclinical data, including insights from Cancer Neuroscience, reveal novel preventive strategies warranting further exploration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preventive strategies against BM in solid tumors are feasible, though data are sparse at this time. Preventing BM requires a personalized, multidisciplinary approach, integrating tumor biology, individual risk assessment, and therapeutic advances. Secondary prevention in patients with BM is as vital as tertiary prevention, warranting prospective validation of preclinical concepts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42466-026-00467-7","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T08:31:56Z","timestamp":1775118716000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preventive strategies against brain metastases: current state of the art and future directions"],"prefix":"10.1186","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6870-1784","authenticated-orcid":false,"given":"Franziska Maria","family":"Ippen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz Felix","family":"Konen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Winkler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"issue":"1","key":"467_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1038\/s41572-018-0055-y","volume":"5","author":"AS Achrol","year":"2019","unstructured":"Achrol, A. 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FFK received honoraria for lectures and travel compensation from Alexion, Argenx, Merck, Novartis, and Takeda. He received research support as fellow of the German Research Foundation (DFG)\u2013 and Hannover Medical School (MHH)-funded Clinician Scientist Program (PRACTIS) at MHH and from Merck, Siemens and Erwin-R\u00f6ver-Foundation. PH received consulting fees from BMS, Glaxo Smith Kline, MSD, Novocure and Servier, honoraria from Lilly, medac, Novocure and Seagen and is in the speakers bureau of Lilly, medac, Novocure, Seagen and Servier. FW holds patents in the field of glioblastoma therapy, and received research support from DC Europa Limited and Glaxo Smith Kline.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"21"}}