Cancer Treatment Today

How to follow a patient with treated brain metastases is becoming a more and more actual clinical problem as treatments that control systemic disease continue to improve. It is not uncommon now to follow a patient for many months or even years after treatment of metastatic disease without new metastases developing. One study reported a median time of 8.8 months to new metastasis after radiosurgery. Patients with 3 or more lesions and cancer histologies

Because irinotecan penetrates the brain-blood barrier and has an effect in primary brain cancer, there is some interest in using it for brain metastasis, especially for lung cancer and breast cancer. Most studies of irinotecan had been for brain mets of small(SCLC) and non-small cell lung cancer(NSMCLC) and not breast cancer and have had mixed results. One study reported complete responses with irinotecan-based chemotherapy for brain metastases in

Biopsying the primary lesions is technically difficult since it is located in the cerebellum. Studies of PET have focused on the population with a biopsy proven source of metastases. For example, in one study of biopsy proven cancer of unknown origin, a survey on clinical usefulness of PET (response rate 83%) suggested that PET positively contributed to diagnostic understanding in 29 of 52 evaluable cases. It concluded that late in the diagnostic

Surgical resection should be considered in patients with single brain metastasis in an accessible location, especially when the size is large, the mass effect is considerable and an obstructive hydrocephalus is present. Radisourgery can also be used. Chemotherapy may be the initial treatment for patients with brain metastases from chemosensitive tumors, like small cell lung cancers, lymphomas, germ cell tumors and breast cancers, especially for chemonaive

Lay Summary: We overview treatment options for brain metastases. Surgical resection should be considered in patients with single brain metastasis in an accessible location, especially when the size is large, the mass effect is considerable and an obstructive hydrocephalus is present. Surgery is recommended when the systemic disease is absent/controlled and the Karnofsky Performance score is 70 or more (level A recommendation). When the combined resection

Motexafin gadolinium is a member of a class of rationally designed porphyrin-like molecules called texaphyrins. The rationale for its use in cancer therapy is that, like naturally occurring porphyrins, it tends to concentrate selectively in cancer cells and it has a novel mechanism of action as it induces redox stress, triggering apoptosis in a broad range of cancers. RECENT FINDINGS: In vitro studies have shown that motexafin gadolinium is synergistic

Several phase II trials have been reported using Temodar(TEM) for patients with brain metastases from solid tumors, including SCLC. In one study, two out of five patients with SCLC pretreated with whole brain radiation therapy showed disease stabilization with TEM. A second study explored the use of whole-brain radiation therapy with concurrent and adjuvant TEM in patients with metastatic cancer and three patients with SCLC were included in this

Lay Summary: RTA-477 is a promising but experimental treatment at this time. RTA 744 is a novel anthracycline that is completing Phase 1 testing. This agent has been well tolerated and has demonstrated excellent activity against brain tumors. Advanced clinical trials of RTA 744 in both primary and secondary (metastatic) brain cancers will be initiated during the second half of 2007. The FDA has granted Orphan Drug designation to RTA 744 for the treatment

In adults the primary tumors most likely to metastatize to the brain are located, in decreasing order, in the lung (minimum 50%), breast (15–25%), skin (melanoma) (5–20%), colon–rectum and kidney, but in general any malignant tumor is able to metastatize to the brain. The primary site is unknown in up to 15% of patients. Brain metastases are more often diagnosed in patients with known malignancy, when they present with neurological findings