Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Emerging and Investigational Therapties for the Treatment of Adults With Metastatic Brain Tumors

QUESTION What evidence is available regarding emerging and investigational treatment options for metastatic brain tumors? TARGET POPULATION Adult patients with brain metastases. RECOMMENDATIONS HIGH-INTENSITY FOCUSED ULTRASOUND There is insufficient evidence to make a recommendation regarding the use of high-intensity focused ultrasound (HIFU) for the treatment of patients with brain metastases. LASER INTERSTITIAL THERMAL THERAPY There is insufficient evidence to make a recommendation regarding the routine use of laser interstitial thermal therapy (LITT), aside from use as part of approved clinical trials. RADIATION SENSITIZERS Level 1: The use of temozolomide as a radiation sensitizer is not recommended in the setting of whole-brain radiotherapy (WBRT) for patients with breast cancer brain metastases. Level 1: The use of chloroquine as radiation sensitizer is not recommended in the setting of WBRT for patients with brain metastases. There is insufficient evidence to make a recommendation regarding the routine use of radiation sensitizers, such as motexafin-gadolinium, sodium nitrite, temozolomide, or chloroquine, in other clinical settings for patients with brain metastases. INTERSTITIAL MODALITIES There is insufficient evidence to make a recommendation regarding the routine use of existing local therapies, such as interstitial chemotherapy, brachytherapy, or other local modalities, aside from their use in approved clinical trials. IMMUNE MODULATORS There is insufficient evidence to make a recommendation regarding the use of immune therapy for brain metastases. MOLECULAR TARGETED AGENTS Level 1: The use of afatinib is not recommended in patients with brain metastasis due to breast cancer. There is insufficient evidence to make recommendations regarding: the use of epidermal growth factor receptor inhibitors erlotinib and gefitinib in patients with brain metastasis due to nonsmall cell lung cancerthe use of BRAF inhibitors dabrafenib and vemurafenib in the treatment of patients with brain metastases due to metastatic melanomathe use of HER2 agents trastuzumab and lapatinib to treat patients with brain metastases due to metastatic breast cancerthe use of vascular endothelial growth factor agents bevacizumab, sunitinib, and sorafenib in the treatment of patients with solid tumor brain metastases. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_9.