Recent Advances in the Management of Brain Metastases in Non-Small Cell Lung Cancer

Continuing Medical Education Information

Recent Advances in the Management of Brain Metastases in Non-Small Cell Lung Cancer

Activity Release Date: October 1, 2007
Activity Expiration Date: October 1, 2008

About the Activity
This activity is based on a brief article developed as part of the E-Update Series and posted on the Web. The series is geared to oncologists and addresses new treatments of cancer or modifications thereof.

This activity has been developed and approved under the direction of Beam Institute.

Activity Learning Objectives
After reading this article, participants should be able to:

• Review the prominent role of whole-brain radiotherapy (WBRT) for patients with multiple brain metastases.
• Discuss the use of focal treatments, in combination with WBRT or alone, in terms of local control and survival.
• Identify several approaches to improving neurocognitive function in patients with brain metastases.
• Summarize the preliminary results of adding radiosensitizers such as motexafin gadolinium and efaproxiral as well as chemotherapy agents to radiotherapy for brain metastases.

Target Audience
This activity targets physicians in the fields of oncology and hematology.

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Beam Institute and The Oncology Group. Beam Institute is accredited by the ACCME to provide continuing medical education for physicians.

Continuing Education Credit
AMA PRA Category 1 Credit™
The Beam Institute designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Compliance Statement
This activity is an independent educational activity under the direction of Beam Institute. The activity was planned and implemented in accordance with the Essential Areas and policies of the ACCME, the Ethical Opinions/Guidelines of the AMA, the FDA, the OIG, and the PhRMA Code on Interactions with Healthcare Professionals, thus assuring the highest degree of independence, fair balance, scientific rigor, and objectivity.

However, Beam Institute, the Grantor, and CMPMedica shall in no way be liable for the currency of information or for any errors, omissions, or inaccuracies in the activity. Discussions concerning drugs, dosages, and procedures may reflect the clinical experience of the author(s) or may be derived from the professional literature or other sources and may suggest uses that are investigational in nature and not approved labeling or indications. Activity participants are encouraged to refer to primary references or full prescribing information resources. The opinions and recommendations presented herein are those of the author(s) and do not necessarily reflect the views of the provider or producer.

Financial Disclosures
Dr. Govindan receives research support from Bristol-Myers Squibb, Eli Lilly, Genentech, Pfizer, Sanofi-Aventis, and serves on the speakers' bureau for Eli Lilly and Genentech. Dr. Mehta is a consultant and speaker for Schering Plough. Dr. Siker has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.

Copyright
Copyrights owned by Beam Institute, a division of CME LLC. Copyright 2007, CME LLC. All rights reserved.

Contact Information
We would like to hear your comments regarding this or other activities provided by Beam Institute. In addition, suggestions for future activities are welcome. Contact us at:

Address:
Director of Continuing Education
Beam Institute
11 West 19th Street, 3rd Floor
New York, NY 10011-4280

Phone: 888-618-5781
Fax: 212-600-3050
e-mail: beaminstitute@cmp.com

Introduction

Lung cancer is one of the most common and deadly malignancies in the United States, with an estimated 213,380 new cases in 2007 and an estimated 160,390 deaths in 2007.¹ Approximately 85% of these patients will be diagnosed with non-small cell lung cancer (NSCLC), and only 10%-20% will have potentially curable disease.

More than 25% of patients with lung cancer develop brain metastases, often the first site of recurrence, occurring more frequently in patients with adenocarcinoma and large cell carcinoma and in those with advanced disease. The incidence of brain metastases in general is believed to be rising due to changing patient demographics with a larger aging population at higher risk for developing malignancies, improved cancer treatments extending survival of patients and allowing the emergence of intracranial disease, new imaging modalities with better sensitivity for detecting occult disease, and the more frequent use of early magnetic resonance imaging (MRI) in staging asymptomatic patients.

Overall survival for patients with brain metastases remains poor. Historically, median survival with supportive care and symptomatic treatment has been only 1-2 months, whereas definitive treatment may extend survival to a median of 4 months. The Radiation Therapy Oncology Group (RTOG) has developed and validated a three-tiered prognostic classification system for patients with brain metastases using recursive partitioning analysis (RPA; Table 1).^2,3 Favorable prognostic factors include a good performance status, a controlled primary tumor, age younger than 65 years, and metastases located in the brain only. Patients in RPA class 1 appear to have the longest median survival following whole-brain radiotherapy (WBRT), whereas patients in RPA classes 2 and 3 seem to survive for significantly shorter periods.