Dr Ahluwalia on Advancements in the Management of Brain Metastases

Manmeet Singh Ahluwalia, MD, MBA, FASCO, chief, Medical Oncology, chief scientific officer, deputy director, Fernandez Family Endowed Chair, Cancer Research, Baptist Health Miami Cancer Institute; neuro-oncologist, Miami Neuroscience Institute, discusses how advancements in precision medicine have improved outcomes for patients with brain metastases across tumor types, as well as future directions for research in this arena, as highlighted in his presentation at the Second Annual Miami Cancer Institute Precision Oncology Symposium.

Over the past 2 decades, significant progress has been made in the management of brain metastases through the development of targeted therapies, immunotherapies, and antibody-drug conjugates (ADCs), Ahluwalia begins. Targeted therapies such as tucatinib (Tukysa) and osimertinib (Tagrisso) have revolutionized outcomes for patients with HER2-positive breast cancer brain metastases and EGFR-mutant lung cancer brain metastases by effectively crossing the blood-brain barrier and exerting potent antitumor effects within the brain, he expands.

Immunotherapies have also ushered in transformative changes, particularly in wild-type lung cancer brain metastases and melanoma brain metastases, Ahluwalia adds. These treatments harness the power of the immune system to combat cancer cells, leading to improved survival rates and quality of life for patients.

More recently, the advent of ADCs has further expanded treatment options for patients with brain metastases, particularly those with HER2-positive breast cancer, Ahluwalia continues. Despite initial doubts about the ability of ADCs to penetrate the blood-brain barrier, these agents have elicited high response rates and efficacy in brain metastatic lesions, he reports.

Looking ahead, the future of brain metastases management holds promise through combination therapies involving ADCs, targeted drugs, and immunotherapies, Ahluwalia says. Questions remain about optimizing treatment sequencing, particularly regarding the integration of radiosurgery into therapeutic regimens, he notes. Radiosurgery has traditionally served as a cornerstone of brain metastases management, and ongoing trials aim to elucidate the most effective strategies for combining radiosurgery with novel systemic therapies, Ahluwalia details.

Programs such as the International Radiosurgery Research Foundation coordinating site located at the Miami Cancer Institute, which collaborates with 40 cancer centers worldwide, are crucial for conducting trials that address these important clinical questions and drive continued advancements in brain metastases management, Ahluwalia adds. Through interdisciplinary collaboration and innovative research, the goal of these programs is to further enhance outcomes and quality of life for patients with brain metastases in the years to come, he concludes.