TAMPA — A phase III trial evaluating routine brain MRI surveillance for patients with metastatic breast cancer was presented at the American Society of Clinical Oncology meeting. Kamran Ahmed, a physician at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, discussed the ongoing study.

The trial seeks to determine the necessity of brain MRI surveillance in stage IV breast cancer. "We have a phase III study that's ongoing to help answer the question of whether brain MRI surveillance in stage IV breast cancer is necessary," Ahmed said. "That will hopefully help provide additional evidence of whether the NCCN [National Comprehensive Cancer Network] guidelines regarding brain MRI surveillance should be changed."

Ahmed said the research examines overall survival and patient quality of life. "We are looking at overall survival in this study," he said. "What we're also looking at is quality of life, so quality-of-life questionnaires are being completed by patients." The study also investigates differences in recommended treatments based on diagnosis timing. "We're also looking at the types of treatment that's being recommended for patients when they are diagnosed," Ahmed said. "So is there a difference when patients are diagnosed when they're asymptomatic versus when they're symptomatic?" He noted this includes differences in radiation therapy types or recommendations for surgical resection. "So differences in terms of the types of radiation therapy that are being recommended to patients, if there's more patients who are being recommended to have surgical resection of their brain metastasis if they're being diagnosed symptomatically," Ahmed said. "So I think all of those are reasons then to potentially consider doing asymptomatic surveillance."

The study balances potential benefits with negative consequences. "Now we also have to balance surveillance with the negative consequences that can arise from having additional imaging, so 'scanxiety,' or anxiety that is related to patient's imaging, that has to be balanced," Ahmed said. He mentioned the potential for asymptomatic disease to be treated without therapy changes. "There's the potential that also asymptomatic disease can be treated fine without additional changes in systemic therapy or local therapy," Ahmed said. He questioned the benefit of early diagnosis given current medications. "More of the medications that patients are being offered in the stage IV setting also may have intracranial activity, like trastuzumab deruxtecan [Enhertu] that can already have some activity," Ahmed said. "So then what is the true benefit of having the diagnosis if asymptomatic disease can already be treated?"

Ahmed noted risks of unnecessary therapies and other factors. "Are we exposing patients to unnecessary risks from additional local therapies, changes to their systemic therapy?" he asked. "And then also incidental findings that might be discovered on an MRI," Ahmed said. "And then there's obviously a cost to doing these MRIs and an additional impact on the healthcare system as well too." He emphasized the need for balance. "So we really have to make sure that the negative consequences of doing MRIs are balanced out by the positive impact," Ahmed said. "So that's what we are hoping to see with this study."