The role of emerging and investigational therapies for metastatic brain tumors: a systematic review and evidence-based clinical practice guideline of selected topics.
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.
Olson
Jeffrey J
JJ
Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Paleologos
Nina A
NA
Gaspar
Laurie E
LE
Robinson
Paula D
PD
Morris
Rachel E
RE
Ammirati
Mario
M
Andrews
David W
DW
Asher
Anthony L
AL
Burri
Stuart H
SH
Cobbs
Charles S
CS
Kondziolka
Douglas
D
Linskey
Mark E
ME
Loeffler
Jay S
JS
McDermott
Michael
M
Mehta
Minesh P
MP
Mikkelsen
Tom
T
Patchell
Roy A
RA
Ryken
Timothy C
TC
Kalkanis
Steven N
SN
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
D008665:Metalloporphyrins; C437683:motexafin gadolinium; D011838:Radiation-Sensitizing Agents