New and Emerging Therapies

The American Association of Neurological Surgeons & the Congress of Neurological Surgeons

What evidence is available regarding the emerging and investigational therapies for the treatment of metastatic brain tumors?

Target population

These recommendations apply to adults with brain metastases.


New radiation sensitizers

Level 2 A subgroup analysis of a large prospective randomized controlled trial (RCT)
suggested a prolongation of time to neurological progression with the early use of
motexafin-gadolinium (MGd). Nonetheless this was not borne out in the overall study
population and therefore an unequivocal recommendation to use the currently available
radiation sensitizers, motexafin-gadolinium and efaproxiral (RSR 13) cannot be

Interstitial modalities

There is no evidence to support the routine use of new or existing interstitial radiation,
interstitial chemotherapy and or other interstitial modalities outside of approved clinical

New chemotherapeutic agents

Level 2 Treatment of melanoma brain metastases with whole brain radiation therapy
and temozolomide is reasonable based on one class II study.
Level 3 Depending on individual circumstances there may be patients who benefit from
the use of temozolomide or fotemustine in the therapy of their brain metastases.

Molecular targeted agents

Level 3 The use of epidermal growth factor receptor inhibitors may be of use in the
management of brain metastases from non-small cell lung carcinoma.