The Evolution and Innovation in Care for Brain Metastases
Care for brain metastases is constantly evolving, and now, physicians can use targeted systemic therapies as well as more focal radiation to treat them.
The evolution of care for brain metastases is currently in “an exciting time,” according to Elizabeth Ren Zhang-Velten, MD, PhD.
During a conversation with CancerNetwork®, Zhang-Velten stated that, in the past, radiation oncologists were mainly responsible for handling a patient’s brain metastasis because it often required radiation to cross the blood-brain barrier. However, there are now targeted systemic therapies that are able to elicit positive central nervous system (CNS) penetrance.
Zhang-Velten, MD, PhD, a radiation oncologist at Keck Medicine of University of Southern California, expressed that radiation has also become more focal as a field, and instead of radiating the whole brain, radiation oncologists can target specific areas. As an example, she highlighted that there are instances where they can completely omit the hippocampi from treatment.
There are also many ongoing trials that may contribute to further advancing care for brain metastases, and she highlighted the NRG-BN012 trial (NCT05438212) investigating the efficacy of adding stereotactic radiotherapy before or after surgery in patients with active brain metastases as one of importance.
Transcript:
It’s an exciting time in terms of care for brain metastases. It used to be [the case] that someone with multiple brain metastases [received care on] the radiation oncologist’s turf because conventional chemotherapy may not cross the blood-brain barrier, which we can treat with radiation. Nowadays…we have some targeted systemic therapies that have good CNS penetrance; for instance, [we have] some good retrospective data for osimertinib…. Even radiation has gotten more focal, and now we don’t [need] to treat the whole brain. We can treat individual spots. If there’s a situation where we do feel we have to treat the whole brain, sometimes, we can spare the hippocampi in certain cases. And then in terms of [care] being a team sport, the patients with 1 metastasis or a metastasis that is causing a lot of symptoms can go for surgical resection. Currently, the role of preoperative vs postoperative stereotactic radiosurgery is being explored in the NRG-BN012 trial.
Reference
Comparing the addition of radiation either before or after surgery for patients with brain metastases. ClinicalTrials.gov. Updated January 22, 2025. Accessed February 11, 2025. https://tinyurl.com/mv62jn9j
