Management of Cancer That Has Spread to the Brain - Episode 1

Cancer Types Associated With Brain Metastases

Priscilla Brastianos, MD, Massachusetts General Hospital of Harvard Medical School

,
Manmeet Ahluwalia, MD, Cleveland Clinic

,
Raymond Sawaya, MD, MD Anderson Cancer Center

,
Vinai Gondi, MD, Northwestern Medicine Cancer Center

,
Ralph DeVitto, American Brain Tumor Association (ABTA)

,
Ivy Elkins, Patient

,
Katie Doble, Patient

,
Nick Doble, Caregiver

Priscilla Brastianos, MD: Hello, and thank you for joining this Cure Connections® program titled “Management of Cancer That Has Spread to the Brain.” Because of the tremendous multidisciplinary approaches being implemented and novel treatments being investigated, the treatment of cancer that has spread to the brain has advanced, showing better effectiveness and safety outcomes.

I am Priscilla Brastianos, the director of the Central Nervous System Metastasis Program at Massachusetts General Hospital, Harvard Medical School, in Boston, Massachusetts. I’m joined by two patients: Ivy Elkins, who will be sharing the details of her journey of being diagnosed with lung cancer, and Katie Doble, who will be sharing the details of her journey of being diagnosed with ocular melanoma. They will share their experiences with learning that the cancer had spread or metastasized to the brain and the care that they received.

We’re also joined by Nick Doble, Katie’s husband and caregiver; Dr. Manmeet Ahluwalia, a brain tumor specialist from the Cleveland Clinic in Cleveland, Ohio; Dr. Raymond Sawaya, a neurosurgeon from The University of Texas MD Anderson Cancer Center in Houston, Texas; Dr. Vinai Gondi, a radiation oncologist from the Northwestern Medicine Cancer Center in Warrenville, Illinois; and Ralph DeVitto, patient advocate representative from the American Brain Tumor Association in Chicago, Illinois. Thank you all so much for joining us. Let’s get started.

First, let’s talk about the risk of brain metastases from different cancers, and let’s start with Dr. Ahluwalia. Dr. Ahluwalia, tell us about which cancer types are most associated with the development of brain metastases, and how prevalent are brain metastases in terms of the overall cancer diagnosis?

Manmeet Ahluwalia, MD: Thanks so much, Dr Brastianos, for the invitation to participate in this roundtable with these patient advocates and these luminaries. As you know, brain metastases are a common clinical problem. It is estimated that every year, 200,000 to 300,000 patients will be diagnosed with brain metastases. We do know that there are some cancers that have a propensity to go to the brain. The most common cancer that results in brain metastases is lung cancer, followed by breast cancer, melanoma, and renal cell. These four cancers typically constitute 85% to 90% of the cases of brain metastases that we encounter in our clinic every day.

What is also very important, and this session is very timely, is that the incidence of brain metastases is increasing because although we have systemic therapies that are taking care of cancers in a better manner, the brain is a sanctuary site. So there is a higher likelihood of brain metastases resulting from good systemic control.

Also, we are getting better with our imaging. A lot of clinical trials require you to have brain imaging before you go on clinical trial, so we may find incidental brain metastases in those patients who may be asymptomatic. If someone has a stage IV lung cancer, for example, the NCCN [National Comprehensive Cancer Network] Guidelines recommend a brain MRI, even at the time of diagnosis, because 20% patients who have stage IV lung cancer can have brain metastases at diagnosis. If they are treated and did not have brain metastases at diagnosis, but they’re alive two years out, their chances of developing brain metastases goes up to 80%. We see more of these patients at our clinics, and we are very excited because we have better therapies to take care of these patients when we see them.

Transcript Edited for Clarity