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, said, "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."

"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. He added, "I think that we want to see some sort of clear benefit."

"We are looking at overall survival in this study," Ahmed said. "What we're also looking at is quality of life, so quality-of-life questionnaires are being completed by patients."

"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 differences in radiation therapy recommendations and surgical resection frequency based on diagnostic stage.

"So I think all of those are reasons then to potentially consider doing asymptomatic surveillance," Ahmed said. However, he cautioned, "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."

"There's the potential that also asymptomatic disease can be treated fine without additional changes in systemic therapy or local therapy," Ahmed said. He pointed out that newer medications used in stage IV settings, such as trastuzumab deruxtecan, may already possess intracranial activity. "So then what is the true benefit of having the diagnosis if asymptomatic disease can already be treated?"

"Are we exposing patients to unnecessary risks from additional local therapies, changes to their systemic therapy?" Ahmed asked. He also cited incidental findings discovered on MRIs and the financial cost to the healthcare system as factors. "So all of those are negative consequences of MRIs as well too," he said. "So we really have to make sure that the negative consequences of doing MRIs are balanced out by the positive impact. So that's what we are hoping to see with this study."