Management of brain metastases in older adults with non-small cell lung cancer.

Brain metastases (BrM) are a major cause of morbidity in patients with non-small-cell lung cancer (NSCLC). As global populations age and systemic therapies improve survival, the number of older individuals presenting with BrM continues to rise. However, older adults remain underrepresented in clinical trials. Thus, treatment decisions in this population are often based on limited evidence from randomized prospective studies. Beyond chronological age, older adults with cancer frequently present with multiple comorbidities, frailty, baseline cognitive impairment, and reduced physiologic reserve. These factors may contribute to suboptimal treatment in clinical practice and highlight that age alone is an insufficient surrogate for vulnerability, underscoring the need for individualized geriatric assessment. In this review, we summarize the available evidence for CNS-directed and systemic therapies in older patients with NSCLC and BrM, discuss the options for local and systemic treatment strategies, and examine how geriatric assessment tools can inform individualized treatment decisions in this underrepresented population.