Thoughtful.

The NRG CC001 publication has generated quite a bit of correspondence in the Journal of Clinical Oncology. You should recall this trial demonstrated that hippocampal avoidance whole brain radiation (HA-WBRT) with memantine reduced the risk of cognitive failure compared to conventional WBRT.  The cognitive benefits were manifest 4-6 months after treatment, but there was no improvement in overall survival (which wasn’t really the purpose). The correspondence gets at the questions of whether clinicians and payers should be adopting HA-WBRT as a standard option for treating patients with brain metastases. Arguments for caution include a lack of improvement in oncologic outcomes and potentially unknown long-term outcomes of considerably higher dose heterogeneity in the brain seen in HA-WBRT plans. But ultimately, the sentiment is that payers should cover HA-WBRT and clinicians should learn to appropriately provide the treatment to carefully selected patients. TBL: CC001 was a large randomized trial supported by well-planned early phase trials that met its intended goal of reducing the neurocognitive burden of whole brain radiation. | Various authors, J Clin Oncol 2020