title: The role of emerging and investigational therapies for metastatic brain tumors: a systematic review and evidence-based clinical practice guideline of selected topics.
abstract: OBJECTIVE
  What evidence is available regarding the emerging and investigational therapies for the treatment of metastatic brain tumors?
  
  
  METHODS
  These recommendations apply to adults with brain metastases.
  
  
  CONCLUSIONS
  New radiation sensitizers Level 2 A subgroup analysis of a large prospective randomized controlled trial (RCT) suggested a prolongation of time to neurological progression with the early use of motexafin-gadolinium (MGd). Nonetheless this was not borne out in the overall study population and therefore an unequivocal recommendation to use the currently available radiation sensitizers, motexafin-gadolinium and efaproxiral (RSR 13) cannot be provided. Interstitial modalities There is no evidence to support the routine use of new or existing interstitial radiation, interstitial chemotherapy and or other interstitial modalities outside of approved clinical trials. New chemotherapeutic agents Level 2 Treatment of melanoma brain metastases with whole brain radiation therapy and temozolomide is reasonable based on one class II study. Level 3 Depending on individual circumstances there may be patients who benefit from the use of temozolomide or fotemustine in the therapy of their brain metastases. Molecular targeted agents Level 3 The use of epidermal growth factor receptor inhibitors may be of use in the management of brain metastases from non-small cell lung carcinoma.
authors: Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
authors: Jeffrey J
authors: JJ
authors: Olson
authors: Nina A
authors: NA
authors: Paleologos
authors: Laurie E
authors: LE
authors: Gaspar
authors: Paula D
authors: PD
authors: Robinson
authors: Rachel E
authors: RE
authors: Morris
authors: Mario
authors: M
authors: Ammirati
authors: David W
authors: DW
authors: Andrews
authors: Anthony L
authors: AL
authors: Asher
authors: Stuart H
authors: SH
authors: Burri
authors: Charles S
authors: CS
authors: Cobbs
authors: Douglas
authors: D
authors: Kondziolka
authors: Mark E
authors: ME
authors: Linskey
authors: Jay S
authors: JS
authors: Loeffler
authors: Michael
authors: M
authors: McDermott
authors: Minesh P
authors: MP
authors: Mehta
authors: Tom
authors: T
authors: Mikkelsen
authors: Roy A
authors: RA
authors: Patchell
authors: Timothy C
authors: TC
authors: Ryken
authors: Steven N
authors: SN
authors: Kalkanis
mesh_terms: D006801:Humans; D000971:Antineoplastic Combined Chemotherapy Protocols; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D016371:Cranial Irradiation / Q000379:methods; D018450:Disease Progression; D019317:Evidence-Based Medicine; D008665:Metalloporphyrins / Q000627:therapeutic use; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D008665:Metalloporphyrins; C437683:motexafin gadolinium; D011838:Radiation-Sensitizing Agents