Brain mets: hippocampus-sparing WBRT plus memantine preserves cognitive function

  • Brown PD & al.
  • J Clin Oncol
  • 14 Feb 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • Whole-brain radiotherapy (WBRT) with hippocampal avoidance (HA) plus memantine for patients with brain metastases resulted in lower deterioration of executive function, learning, and memory, as well as less fatigue.

Why this matters

  • Radiation exposure to the neuroregenerative zone of the hippocampus has been linked to cognitive toxicity.

Study design

  • In a phase 2 trial, 518 patients with solid tumor malignancy and brain metastases outside a 5-mm margin around the hippocampus were randomly assigned to either HA-WBRT plus memantine or WBRT plus memantine.
  • Funding: National Cancer Institute.

Key results

  • Risk for cognitive failure was significantly lower in the HA-WBRT plus memantine group than the WBRT plus memantine group (adjusted HR, 0.74; P=.02).
  • HA-WBRT plus memantine vs WBRT plus memantine had:
    • Less deterioration in executive function at 4 months:
      • 23.3% vs 40.4% (P=.01).
    • Less deterioration at 6 months in:
      • Learning: 11.5% vs 24.7% (P=.049); and
      • Memory: 16.4% vs 33.3% (P=.02).
    • Less fatigue (P=.04).
    • Less difficulty remembering things (P=.01) and speaking (P=.049).
    • Less interference of neurologic symptoms in daily activities (P=.008).
    • Fewer cognitive symptoms (P=.01).

Limitations

  • Participants were not blinded to treatment.