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. 2019 Dec;19(6):383-391.
doi: 10.1016/j.clbc.2019.05.018. Epub 2019 Jun 5.

Diagnostic Clinical Trials in Breast Cancer Brain Metastases: Barriers and Innovations

Jawad Fares  1 , Deepak Kanojia  1 , Aida Rashidi  1 , Atique U Ahmed  1 , Irina V Balyasnikova  1 , Maciej S Lesniak  2
Affiliations

Diagnostic Clinical Trials in Breast Cancer Brain Metastases: Barriers and Innovations

Jawad Fares et al. Clin Breast Cancer. 2019 Dec.

Abstract

Optimal treatment of breast cancer brain metastases (BCBM) is often hampered by limitations in diagnostic abilities. Developing innovative tools for BCBM diagnosis is vital for early detection and effective treatment. In this study we explored the advances in trial for the diagnosis of BCBM, with review of the literature. On May 8, 2019, we searched ClinicalTrials.gov for interventional and diagnostic clinical trials involving BCBM, without limiting for date or location. Information on trial characteristics, experimental interventions, results, and publications were collected and analyzed. In addition, a systematic review of the literature was conducted to explore published studies related to BCBM diagnosis. Only 9 diagnostic trials explored BCBM. Of these, 1 trial was withdrawn because of low accrual numbers. Three trials were completed; however, none had published results. Modalities in trial for BCBM diagnosis entailed magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), PET-CT, nanobodies, and circulating tumor cells (CTCs), along with a collection of novel tracers and imaging biomarkers. MRI continues to be the diagnostic modality of choice, whereas CT is best suited for acute settings. Advances in PET and PET-CT allow the collection of metabolic and functional information related to BCBM. CTC characterization can help reflect on the molecular foundations of BCBM, whereas cell-free DNA offers new genetic material for further exploration in trials. The integration of machine learning in BCBM diagnosis seems inevitable as we continue to aim for rapid and accurate detection and better patient outcomes.

Keywords: Artificial intelligence; Circulating tumor cells; Magnetic resonance imaging; Nanobody; Positron emission tomography.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Clinical trial selection process
Figure 2
Figure 2
Diagnostic modalities of breast cancer brain metastases that are in trial, as of May 8, 2019
See this image and copyright information in PMC

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