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According to a recent article published in the Journal of Clinical Oncology, the agent efaproxiral, which is still in clinical trials, may improve the benefit of radiation therapy to the brain for breast cancer patients with brain metastasis.

Cancer spread to the brain (brain metastasis) is common with several types of cancers. Unfortunately, the typical duration of survival following standard therapy for brain metastasis is less than 5 months. This statistic has not changed over the past 25 years, clearly highlighting a need for improvement in the treatment of brain metastasis.

Standard treatment for brain metastasis may include the surgical removal of the cancer if patients are eligible for surgery (cancer is not widespread in the brain, other health problems do not prohibit surgery to the brain, cancer is located in an operable area of the brain), and/or radiation therapy to the head. Recently, more sophisticated radiation techniques have allowed radiation to be applied in a more precise manner to the areas of cancer in the brain. However, even these advances have not improved survival in patients with several brain metastases.

Radiation therapy relies on the presence of oxygen to create its anti-cancer effects. Results from studies have indicated that areas of cancer often have low levels of oxygen – ultimately reducing the effectiveness of radiation therapy. Efaproxiral is an agent that improves oxygen levels within areas of cancer, allowing radiation therapy to have a greater capacity in killing cancerous cells.

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Researchers form the United States and Canada recently conducted a phase III trial to compare efaproxiral plus radiation therapy to radiation therapy alone (control arm) in cancer patients with brain metastases. The trial included 515 patients with various types of cancer-265 of whom were treated with efaproxiral, oxygen and radiation therapy, and 250 were treated with radiation therapy alone. Some patients benefited from the addition of efaproxiral.

• Overall, the median survival times were 5.4 months for patients treated with efaproxiral and 4.4 months for those on the control arm.

• Patients with breast cancer or non-small cell lung cancer (NSCLC) demonstrated the greatest benefit with a median survival time of 6.0 months for these patients treated with efaproxiral and 4.4 for those on the control arm.

• Anti-cancer responses were improved with the addition of efaproxiral by 13% for patients with breast cancer and 7% for patients with NSCLC compared to the control group.

The researchers concluded that the addition of efaproxiral may improve outcomes for some patients with brain metastases, particularly patients with breast cancer. A clinical trial further evaluating efaproxiral that includes only patients with brain metastases from breast cancer has been initiated.

Reference: Suh J, Stea B, Nabid A, et al. Phase III Study of Efaproxiral As an Adjunct to Whole-Brain Radiation Therapy for Brain Metastases. Journal of Clinical Oncology. 2005; 24: 106-114.

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