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Open Access 01-01-2010 | Invited Manuscript

The role of emerging and investigational therapies for metastatic brain tumors: a systematic review and evidence-based clinical practice guideline of selected topics

Authors: Jeffrey J. Olson, Nina A. Paleologos, Laurie E. Gaspar, Paula D. Robinson, Rachel E. Morris, Mario Ammirati, David W. Andrews, Anthony L. Asher, Stuart H. Burri, Charles S. Cobbs, Douglas Kondziolka, Mark E. Linskey, Jay S. Loeffler, Michael McDermott, Minesh P. Mehta, Tom Mikkelsen, Roy A. Patchell, Timothy C. Ryken, Steven N. Kalkanis

Published in: Journal of Neuro-Oncology | Issue 1/2010

Abstract

Question

What evidence is available regarding the emerging and investigational therapies for the treatment of metastatic brain tumors?

Target population

These recommendations apply to adults with brain metastases.

Recommendations

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.

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Title: The role of emerging and investigational therapies for metastatic brain tumors: a systematic review and evidence-based clinical practice guideline of selected topics
Authors: Jeffrey J. Olson
Nina A. Paleologos
Laurie E. Gaspar
Paula D. Robinson
Rachel E. Morris
Mario Ammirati
David W. Andrews
Anthony L. Asher
Stuart H. Burri
Charles S. Cobbs
Douglas Kondziolka
Mark E. Linskey
Jay S. Loeffler
Michael McDermott
Minesh P. Mehta
Tom Mikkelsen
Roy A. Patchell
Timothy C. Ryken
Steven N. Kalkanis
Publication date: 01-01-2010
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 1/2010
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-009-0058-3

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The role of emerging and investigational therapies for metastatic brain tumors: a systematic review and evidence-based clinical practice guideline of selected topics

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