Insights from MARIPOSA: Impressions of the Intracranial Data
Panelists discuss how intracranial progression-free survival (PFS) and duration of response (DoR) influence treatment decisions, highlighting the significance of intracranial data in differentiating this regimen within the treatment landscape, its potential impact on brain metastases management, and the role of radiation therapy in clinical practice.
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Intracranial PFS and DoR Insights
The regimen appears to improve intracranial activity, potentially enhancing PFS and DoR in brain metastases. This aligns with secondary end point findings from trials such as ADAURA, in which brain-related outcomes were a focus.
Impact on Treatment Decisions
The presence of intracranial efficacy may influence the decision to use this combination therapy, though definitive comparisons with other regimens are challenging due to sample size limitations. Physicians weigh this factor alongside survival benefits and toxicity considerations.
Differentiation From Other Treatments
While the data are promising, the trial lacks a sufficiently large sample to definitively differentiate this regimen from others. The role of radiation therapy remains limited, mainly reserved for large or critically located brain tumors.
Brain Metastases Management
Most patients with small or multiple metastases are managed without upfront radiation, as systemic therapy shows efficacy. Only around 10% to 15% of patients receive radiation, typically for lesions greater than or equal to 2 cm or those in high-risk locations.
Overall, while the data are reassuring for intracranial efficacy, broader comparisons and further studies are needed for conclusive differentiation.
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