When cancer spreads to the brain from a different part of the body, historically life expectancy has been generally poor. In addition, it’s been difficult for doctors to predict survivability. But thanks to groundbreaking work in a three-country study that included Miami Cancer Institute, all of that is changing.
Doctors at the Institute, along with those at 17 other cancer centers in the United States, Canada and Japan, have determined that survival rates for patients with brain metastases are improving, making many eligible for clinical trials and innovative treatments that they would have been previously excluded from. In addition, the researchers developed an algorithm that very accurately predicts prognosis.
“We’ve found that there are subcategories of patients who have substantially better survival ― we’re talking survival in years compared to months,” said Minesh Mehta, M.D. , deputy director and chief of radiation oncology at Miami Cancer Institute. “No longer does one need to speculate or guess to make a prediction on a brain metastases patient’s survival.”
The ability to accurately predict outcomes means that physicians can now identify which patients would be well suited for clinical trials, added Dr. Mehta, who is the senior author of the report that was published recently in the Journal of Clinical Oncology. In the past, most brain metastases patients were excluded from clinical trials and were often referred for palliative care or to hospice.
“If we recognize that these patients can have better survival and enroll them on these trials, we might in fact identify newer agents that are more effective,” Dr. Mehta said.
The study involved examining a database of 6,984 patients whose cancers spread to the brain. According to the American Cancer Society, any cancer can metastasize to the brain, but the most likely cancers to do so are lung, breast, colon, kidney and melanoma. In the U.S. alone, an estimated 300,000 patients are diagnosed each year with brain metastases, which is the most common type of brain cancer today. This is largely due, experts say, to advances that have allowed patients with many types of cancer to live longer.
Among the study’s findings: Median survival of brain metastases has improved over the years, but varies by subset: lung cancer, 7-47 months; breast cancer, 3-36 months; melanoma, 5-34 months; gastrointestinal cancer, 3-17 months; and renal cancer, 4-36 months.
Taking many factors into consideration, the researchers were able to refine and simplify the Graded Prognostic Assessment (GPA) index that physicians have used in the past in an attempt to predict outcomes for patients with brain metastases. The index, or rating, goes from a 4.0, which correlates with the best prognosis, to a 0.0. The updated GPA tool is available for free for clinicians.
“Our tool is extremely accurate and helpful in guiding a patient’s decision-making. It allows for a robust and accurate discussion of options between the patient and the clinician in a matter of minutes,” Dr. Mehta said.