Vogelbaum MA, Brown PD, Messersmith H, Brastianos PK, Burri S, Cahill D, Dunn IF, Gaspar LE, Gatson NTN, Gondi V, Jordan JT, Lassman AB, Maues J, Mohile N, Redjal N, Stevens G, Sulman E, van den Bent M, Wallace HJ, Weinberg JS, Zadeh G, and Schiff D
Purpose: To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors., Methods: ASCO convened an Expert Panel and conducted a systematic review of the literature., Results: Thirty-two randomized trials published in 2008 or later met eligibility criteria and form the primary evidentiary base., Recommendations: Surgery is a reasonable option for patients with brain metastases. Patients with large tumors with mass effect are more likely to benefit than those with multiple brain metastases and/or uncontrolled systemic disease. Patients with symptomatic brain metastases should receive local therapy regardless of the systemic therapy used. For patients with asymptomatic brain metastases, local therapy should not be deferred unless deferral is specifically recommended in this guideline. The decision to defer local therapy should be based on a multidisciplinary discussion of the potential benefits and harms that the patient may experience. Several regimens were recommended for non-small-cell lung cancer, breast cancer, and melanoma. For patients with asymptomatic brain metastases and no systemic therapy options, stereotactic radiosurgery (SRS) alone should be offered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma. SRS alone to the surgical cavity should be offered to patients with one to two resected brain metastases. SRS, whole brain radiation therapy, or their combination are reasonable options for other patients. Memantine and hippocampal avoidance should be offered to patients who receive whole brain radiation therapy and have no hippocampal lesions and 4 months or more expected survival. Patients with asymptomatic brain metastases with either Karnofsky Performance Status ≤ 50 or Karnofsky Performance Status < 70 with no systemic therapy options do not derive benefit from radiation therapy.Additional information is available at www.asco.org/neurooncology-guidelines., Competing Interests: Michael A. VogelbaumStock and Other Ownership Interests: Infusion TherapeuticsHonoraria: Tocagen, Celgene, Cellinta, Plus TherapeuticsResearch Funding: Celgene (Inst), OncoSynergy (Inst), Denovo Biopharma (Inst)¸ Olympus (Inst)Patents, Royalties, Other Intellectual Property: Patents for drug delivery devices for the brain Paul D. BrownHonoraria: UpToDate Priscilla K. BrastianosHonoraria: PfizerConsulting or Advisory Role: ElevateBio, Dantari Pharmaceuticals, SK Life Sciences, Pfizer, Voyager Therapeutics, SinteticaResearch Funding: Merck (Inst), Bristol Myers Squibb (Inst), Lilly (Inst), Mirati Therapeutics (Inst) Stuart BurriEmployment: Southeast Radiation Oncology GroupStock and Other Ownership Interests: Southeast Radiation Oncology Group, Radiation Oncology Centers of the CarolinasTravel, Accommodations, Expenses: NovocureOther Relationship: Novocure Dan CahillStock and Other Ownership Interests: Pyramid BiosciencesConsulting or Advisory Role: Lilly, Boston Pharmaceuticals, GlaxoSmithKline Laurie E. GasparEmployment: Banner MD Anderson ColoradoSpeakers' Bureau: Cancer Experts NowOther Relationship: NCIOpen Payments Link: https://openpaymentsdata.cms.gov/physician/275039/summary Na Tosha N. GatsonHonoraria: NovocureConsulting or Advisory Role: NovocureTravel, Accommodations, Expenses: Novocure Vinai GondiHonoraria: UpToDate Justin T. JordanStock and Other Ownership Interests: Navio TheragnosticsConsulting or Advisory Role: Guidepoint Global, ClearView Healthcare Partners, Recursion Pharmaceuticals, GLG, CereXis, Navio Theragnostics, Health2047, EMP Advisory,Patents, Royalties, Other Intellectual Property: Textbook royaltiesExpert Testimony: Medical Mutual Insurance of MaineOther Relationship: Shepherd Therapeutics, Shepherd Foundation, Neurofibromatosis Network, American Academy of Neurology (AAN) Andrew B. LassmanHonoraria: Abbott MolecularConsulting or Advisory Role: Karyopharm Therapeutics, Sapience Therapeutics, QED Therapeutics, FORMA Therapeutics, Bayer, Orbus Therapeutics, BioClinica, Novocure, Elsevier, Vivacitas OncologyResearch Funding: AbbVie (Inst), Novartis (Inst), Genentech/Roche (Inst), Aeterna Zentaris (Inst), Celldex (Inst), Kadmon (Inst), BeiGene (Inst), VBI Vaccines (Inst), Pfizer (Inst), Millennium (Inst), Oncoceutics (Inst), Karyopharm Therapeutics (Inst), Bayer (Inst), QED Therapeutics (Inst), Agios (Inst), Orbus Therapeutics (Inst), BMS (Inst), RTOG Foundation (Inst)Patents, Royalties, Other Intellectual Property: ElsevierTravel, Accommodations, Expenses: AbbVie, BioClinica, Abbott Molecular, FORMA Therapeutics, Karyopharm Therapeutics, QED Therapeutics, Bayer, Novartis, Pfizer, VBI Vaccines Julia MauesHonoraria: Pfizer, AstraZenecaConsulting or Advisory Role: AstraZeneca Nimish MohileConsulting or Advisory Role: Sapience TherapeuticsResearch Funding: Vascular Biogenics, Boston Biomedical, Quell, Tocagen Erik SulmanHonoraria: Merck Sharp & Dohme, Novocure, Zai LabConsulting or Advisory Role: Merck Sharp & Dohme, NovocureResearch Funding: Novocure (Inst)Travel, Accommodations, Expenses: Merck Sharp & Dohme, Novocure, Brainlab, PER, Zai Lab Martin van den BentThis author is a member of the Journal of Clinical Oncology Editorial Board. Journal policy recused the author from having any role in the peer review of this manuscript.Employment: AstraZeneca (I)Consulting or Advisory Role: AbbVie, Bristol Myers Squibb, Celgene, Agios, Boehringer Ingelheim, Bayer, Carthera, Genenta Science, Nerviano Medical Sciences, Boston PharmaceuticalsResearch Funding: AbbVie (Inst) Jeffrey S. WeinbergConsulting or Advisory Role: OsteoMed David SchiffConsulting or Advisory Role: Orbus Therapeutics, GlaxoSmithKline, PRA, AstraZenecaResearch Funding: Bayer (Inst)No other potential conflicts of interest were reported.