Aizer on Personalizing Radiation for Brain Metastases

In an interview with Targeted Oncology^TM, Ayal Aizer, MD, MHS, a brain radiation oncologist at Brigham and Women's Hospital and Dana-Farber Cancer Institute, discusses an abstract from this year's American Society of Clinical Oncology (ASCO) Annual Meeting exploring the use of stereotactic radiation therapy in patients with brain metastases.

For patients with brain metastases, radiation therapy is a primary treatment. While SRT has shown improved quality of life over whole brain radiation (WBRT) for those with fewer brain metastases, data for patients with more than 4 lesions has been limited. Additionally, no prior studies compared SRT directly with hippocampal avoidance WBRT (HA-WBRT), a technique known to be superior to traditional WBRT.

To address this gap, a multicenter, phase 3 randomized trial was conducted between April 2017 and May 2024. The study enrolled 196 patients (98 per arm) aged 18 to 80, each with 5 to 20 brain metastases from solid primary cancers (excluding small cell lung cancer), no prior brain radiation, and no leptomeningeal disease. The primary goal was to assess patient-reported symptom severity and interference using the MD Anderson Symptom Inventory–Brain Tumor (MDASI-BT) over six months.

Results demonstrated that the SRT arm exhibited significantly lower overall symptomatology and interference compared to the HA-WBRT arm, meeting the study's primary endpoint. Specifically, SRS/SRT led to lower symptom severity less interference in daily function.

However, according to Aizer, many questions remain unanswered in the field of brain metastases, particularly concerning radiation treatment. While clinicians continually strive to improve radiation's efficacy for individual patients, there is a significant gap compared to advancements in medical oncology.

Those in medical oncology have excelled at tailoring therapies for specific patient subsets. For example, in non–small cell lung cancer, mutational assays and immune markers guide systemic treatment decisions, moving away from a one-size-fits-all approach, according to Aizer.

To Aizer, the field urgently needs to reach a similar level of personalization for patients with brain metastases. This means being able to determine the optimal radiation strategy for each individual. Currently, despite some minor variations, the approach to radiation for brain metastases is largely standardized. Greater personalization of care would undoubtedly be beneficial, according to Aizer. Achieving this requires better data to inform these individualized strategies. A key objective for the coming years is to gather this data, enabling clinicians to tailor radiation for brain metastases to individual patient needs and then rigorously test these personalized strategies in clinical trials.