For patients with non-small cell lung cancer
with brain metastases, treatment with whole brain radiotherapy may not offer much benefit.
Early results from an ongoing trial suggest that pembrolizumab has promising activity in untreated melanoma patients
with brain metastases.
Subgroup analyses showed benefit with the combination in all groups, with the exception of
those with brain metastases at baseline, though this included a total of only 12 patients.
[22] Formal data on other compounds in development, including ASP8273, PF - 7775, EGF816, and HM61713, in patients
with brain metastases are still awaited.
[21] In the recently presented FLAURA study, in which osimertinib was used in untreated patients with advanced EGFR - mutant NSCLC, the HR for systemic disease control and CNS control similarly favored osimertinib over erlotinib or gefitinib, supporting the preclinical data that showed osimertinib's penetration across the BBB and providing support for using this agent in first - line management of EGFR - mutant patients
with brain metastases.
Safety and clinical activity of ipilimumab in melanoma patients
with brain metastases: retrospective analysis of data from a phase 2 trial.
[32] In patients
with brain metastases in the AZD3759 phase I clinical trial, 63 % (12 of 19 patients) achieved an intracranial response and 50 % (10 of 20 patients) had an extracranial response.
While therapies that target HER2 and HER3 are clinically available, clinical trials often exclude patients
with brain metastases.
Whole brain radiotherapy (WBRT) significantly improves tumor control in the brain after SRS, yet because of its association with cognitive decline, its role in the treatment of patients
with brain metastases remains controversial.
«Rare mutation may extend survival in lung cancer patients
with brain metastases.»
The study used samples from lung cancer patients
with brain metastases.
Many lung cancer trials have traditionally excluded patients
with brain metastases at baseline, expecting that the presence of metastases would create negative results that could in turn create the appearance of drug failure.
Not exact matches
This means that when we rely on analysis of a primary tumour we may miss mutations in the
brain metastases that we could potentially target and treat effectively
with drugs.»
Research from McMaster University has identified new regulators of
brain metastases in patients
with lung cancer.
«If you look at a set of lung cancer patients, like we did in the paper, who develop
brain metastases, they all have those two genes in their primary lung cancer,» said Sheila Singh, the study's supervisor, associate professor at the Michael G. DeGroote School of Medicine, scientist
with the Stem Cell and Cancer Research Institute at McMaster University and neurosurgeon at McMaster Children's Hospital.
Since whole -
brain radiation is associated
with significant cognitive effects and the use of additional radiation therapy for progression is common in this population, the Yale researchers suspect that patients
with the ALK mutation would benefit from radiation focused on individual
metastases.
A pre-surgery tumor size of greater than three centimeters was associated
with worse LC, but local recurrence was not significantly affected by the number of
brain metastases or the patients» histology or graded prognosis assessments.
Approximately 30 percent of patients
with cancer develop
brain metastases, and the incidence of these lesions is rising.
Paul D. Brown, M.D., of Mayo Clinic, Rochester, Minn., and colleagues conducted a study in which 213 patients
with 1 to 3
brain metastases were randomly assigned to receive SRS alone (n = 111) or SRS plus WBRT (n = 102).
In the case of breast cancer driven by overexpression of the HER2 gene, up to 50 percent of patients treated
with targeted therapies eventually develop
brain metastases, which are inevitably fatal.
While neither a drug that targets HER3 nor one that interferes
with the interaction between HER2 and HER3 were able to slow the growth of
brain metastases, combined treatment
with both an anti-HER2 and an anti-HER3 drug significantly slowed tumor growth.
«Stem cell - based therapy for targeting skin - to -
brain cancer: Stem cells loaded
with oncolytic viruses show promising results in preclinical models for targeting skin cancer
metastases in the
brain.»
A phase 3 trial of whole
brain radiation therapy and stereotactic radiosurgery alone versus WBRT and SRS
with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3
brain metastases: Radiation Therapy Oncology Group 0320.
Subjects
with known
brain metastases.
Novel strategies that are effective in treating
brain metastases in patients
with lung cancer are needed.
[38] A retrospective study of 90 patients
with ALK - rearranged NSCLC metastatic to the
brain found that OS after the development of
brain metastases was still prolonged at approximately 4 years (49.5 months),
with patients frequently having multiple opportunities for salvage SRS at recurrence; 45 % of patients on follow - up had progressive
brain metastases at death.
[38] The median time to CNS progression was 7 months in patients
with previously untreated
brain metastases.
Undergoing immunotherapy within a month of stereotactic radiosurgery resulted in an improved response to treatment for patients
with melanoma
brain metastases.
It has been suggested to replace the diagnosis - specific graded prognostic assessment (DS - GPA, based on performance status and number of
brain metastases) for patients
with primary malignant melanoma
with the new Melanoma - molGPA.