Options after Brain mets - 1247593

Hello Barinder, I'm so sorry your father is not better.

You may have already found this in a search. Dr. West's comments on possible treatments after wbr.

"These are all in the range of really untested concepts. Some chemo agents, ranging from Temodar (temazolamide), Camptosar (irinotecan), and Alimta (pemetrexed) have all had a few reports of inducing responses in the brain more commonly than some others, but that's pretty scant evidence, frankly. If there were a situation in which I think there would be more hope for pulsed Tarceva (erlotinib) to treat disease in the central nervous system, it would be in someone with an activating EGFR mutation, but especially in someone who has already been on Tarceva, we just don't know. And I really don't know any way to estimate the likely benefit vs. risk of the two pulsed therapy approaches you mentioned, though I personally would be more wary about the 1500 mg weekly approach in terms of potential adverse effects. I suppose the key question would be whether it were a situation in which it's felt that there's nothing to lose by trying." http://cancergrace.org/forums/index.php?topic=9788.0

And this quote about srs after wbr, "It’s not unusual to recommend stereotactic radiosurgery (SRS) after whole brain radiation (WBR) if there are one or a few areas progressing. Options are certainly limited in that setting, and SRS is a leading option. However, it’s not especially common to do WBR with a plan to go straight to SRS without even seeing the outcome of the WBR. And yes, it takes weeks to even a few months to really be able to assess the results of WBR." http://cancergrace.org/cancer-treatments/topic/steriotactic-radiation-a…

Barinder, if you are having difficulty accessing our search you may need to log out then search. It's an odd and unfortunate glitch of wordpress that certain browsers don't work with it.

I hope it helps,
Janine
forum moderator

I think Janine found most of what I'd have to say. Systemic therapies really don't tend to have much efficacy against brain metastases, at least those that have grown after brain radiation. Stereotactic radiosurgery is very good for one or a few lesions, and whole brain radiation (WBR) is ideal for multiple lesions, but after WBR has been given, there are just no treatments that have a very good track record. We sometimes try repeat WBR, and I have one patient who has done very well for years after doing that, but it's not very well studied, and it's always something we're concerned about in terms of potentially significant cognitive side effects. Here's more information on re-irradiation:

http://cancergrace.org/radiation/2008/12/07/reirrad-brain-mets-zg/

However, I just don't think I can honestly say that I think there's a systemic therapy we know about that has much of a meaningful chance of being truly beneficial about brain metastases growing after WBR.

-Dr. West