[Comment] Systemic therapy for brain metastases: a changing landscape

In addition to next generation small molecule tyrosine-kinase inhibitors,1,2 large molecular weight antibody–drug conjugates (ADCs) have shown CNS-specific activity, penetrating a blood–brain barrier that is disrupted by local therapies, the presence of brain metastases, or both.3 The adoption of these CNS-penetrant systemic therapies to treat patients with active brain metastases is increasingly accepted in routine practice, despite little data from randomised trials.