Brain Metastases: Standard of Care and Novel Therapies (Podcast)

Brain metastases is a relative bright spot in the larger realm of brain tumor care, as advances in therapy in recent years have allowed the vast majority of patients to enjoy many years of longevity with good tumor control and high quality of life.

A new episode of Cleveland Clinic’s peer-to-peer Neuro Pathways podcast explores those advances in detail with neurosurgeon Gene Barnett, MD, MBA, and neuro-oncologist Manmeet Ahluwalia, MD, who respectively serve as Director and Associate Director of the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center at Cleveland Clinic. They touch upon the following topics, among others:

• The evolution of surgical treatment of brain metastases through stereotactic radiosurgery and stereotactic laser ablation
• Two therapeutic avenues that have recently overcome longstanding limitations of chemotherapy for brain metastases
• Why patients with brain metastases derive particular value from multidisciplinary team-based care

Click the player below to listen to the 15-minute podcast now, or read on below for an edited excerpt that gives a taste of the discussion. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Dr. Ahluwalia: I think we are in some ways at an inflection point for patients with brain metastases because, as Dr. Barnett mentioned, we’ve had a very strong radiosurgery program over the years. We also have avenues like LITT [laser interstitial thermal therapy] where we can help those patients for whom radiosurgery doesn’t work very well. But we now also have these exciting novel therapies like immunotherapies and targeted therapies.

So when we discuss the management of these patients in our brain tumor board or in the clinic, we are now focusing on what are the best ways to combine these approaches. For example, radiosurgery can be combined relatively easily with most of our targeted therapies or immunotherapies. So that is what we are increasingly doing, particularly in the context of clinical trials. For example, we have a clinical trial of this drug known as osimertinib, which is a targeted therapy that works extremely well against EGFR-directed brain metastases. We have a trial underway where we are combining radiosurgery with osimertinib. A big focus of our efforts is to look at these types of combinatorial approaches for the future.