Advances in the Treatment of Spinal Metastasis: Commentary on “Spinal Metastases and the Evolving Role of Molecular Targeted Therapy, Chemotherapy, and Immunotherapy”

Spinal metastasis is a common complication of systemic cancer progression, and recur-rent or radiation-refractory disease remains a significant clinical challenge. Over the past two decades, an increased understanding of the biology of cancer has led to the development of new therapies. Spine surgeons should be knowledgeable about systemic cancer therapies, as it informs the planning of surgical interventions. While the impact of these therapies on the systemic and visceral response of cancer is well-documented, most clinical trials do not specifically record the response of spinal metastatic disease. Thus, more infor-mation on the response of spinal metastasis to new treatments is needed to inform surgical decision-making. In their review, Fomchenko et al. 1 summarize the incidence and treatment options for spinal metastasis from primary non-small cell lung cancer, breast cancer, melanoma, renal cell carcinoma, prostate cancer, and thyroid cancers. Collectively, these primary cancers account for over 55% of all spine metastases diagnosed in the United States. 2 The authors are to be commended for their comprehensive review of the targeted molecular therapies, che-motherapies, and immunotherapies for these cancers. The review also provides the authors’ own examples of patients with spinal metastatic disease who significantly responded to newer therapies, which resulted in avoidance of spinal surgery. These clinical cases demon-strate effective local control within the spine following treatment with chemotherapy, targeted therapy, immunotherapy, and radiotherapy. Awareness of these responses can help with timing and planning of surgical interventions, as well as allow development of an indi-vidualized treatment strategy for patients with spinal metastasis. Long-term survival data show that patients with spinal metastases are living longer. 2 These survival gains reflect a combination of earlier detection and more efficacious medical therapy