Locked on target.

Top Line: With increasing effectiveness of systemic therapy, more and more patients are living to see eventual development of metastasis in that dreaded sanctuary site, the brain.

The Study: Unfortunately, many trials evaluating novel therapies exclude intracranial disease, and med oncs are left scratching their heads over whether intracranial progression indicates a need to change systemic therapy. To cover the most common etiologies of brain mets, as well as common indications for targeted therapies, this Canadian cancer registry study included all patients receiving targeted therapies for HER2+ breast cancer (n=782), EGFR-mutant lung cancer (n=693), or BRAF-mutant melanoma (n=173) who at some point developed brain mets. Indeed, on multivariate analysis, a diminished risk of death was observed in this real-world cohort among those who, after a diagnosis of brain mets, initiated or continued to receive HER2- (n=314, HR 0.40-0.46), EGFR- (n=415, HR 0.28), or BRAF- (n=93, HR 0.20) targeted therapies. Granted, buried in the supplement you will find similar advantages with post-brain mets receipt of non-targeted systemic therapies and, that’s right, brain radiation. While we would love to suggest irradiating brain mets significantly prolongs survival, we’re guessing all of these therapies were offered to patients with better outlooks.

TBL: If patients are doing otherwise well with their targeted therapy, brain mets alone doesn’t necessitate switching to more toxic systemic therapy, and here’s a friendly reminder that no systemic therapy supplants the benefit of brain radiation. | Erikson, JAMA Oncol 2021