The impact of a dedicated multidisciplinary tumor board on care for patients with brain metastases.

Abstract

e13585 Background: Brain metastases are the most common tumors to affect the central nervous system. Treatment options have recently evolved with the use of targeted therapies, immunotherapy, and increased clinical trials availability. We describe our institutional experience with a novel, weekly tumor board dedicated to brain metastases and its impact on treatment decisions and survival. Methods: We conducted a single institution cohort study at a large academic hospital with a dedicated center for CNS metastases. Attendance at tumor board included representatives from neuro-oncology, medical oncology, radiation oncology, neurosurgery, and neuroradiology. We prospectively gathered data on patient demographics, clinical history, and tumor board recommendations. Patients were followed to assess treatment course and survival. The Kaplan Meier method was used to calculate time to progression. Results: A total of 49 patients were presented over 2 months, with 4 patients presented twice. The median age at presentation was 63 yrs with a median ECOG of 1. The primary malignancy was 35% melanoma, 49% lung, 22% breast, the remainder other. Most patients had advanced, heavily pretreated disease: 69% had Stage IV disease at time of tumor board presentation with a median of 2 prior lines of systemic therapy, 73% had multiple brain metastases, 39% had prior surgical resection of brain metastases, and 57% had prior CNS radiation. The tumor board recommended a change in management in 26/53 case presentations: 5 surgery, 8 radiation, 9 medical therapy, 3 clinical trial, and 1 surveillance. Recommendations were followed in all except 4 cases due to patient preference and loss to follow-up. When active therapy was recommended, the median time to start was 7 days. Only 3 patients have died at a median follow-up of 62 days. 9 patients have progressed, with a median time to progression of 57 days. Conclusions: A multidisciplinary brain metastasis tumor board provides unique opportunities in the management of complex brain metastasis patients in an era of rapidly evolving therapeutic options. Additional follow-up is needed to assess long-term outcomes, and comparison to non-tumor board presented patients will be necessary.