As people are now surviving longer with cancer, many of them come to see their cancer spread to their brain or spine. The Duke Center for Brain and Spine Metastasis (DCBSM) brings together a multidisciplinary team of clinical and research experts from neurosurgery, medical oncology, radiation oncology, and palliative care who seek new answers for these patients from bench to bedside.

New Discoveries

New therapies for cancer often start with a discovery in the laboratory, at the bench with cells or animals. In the DCBSM, we are focused on the bench-to-bedside development of novel therapeutic strategies for brain and spine metastasis, including leptomeningeal disease.

• Ann Marie Pendergast, PhD, is a world-renowned expert in ABL kinases. Using an ABL inhibitor already available in the clinic, she and her team have identified ABL kinases as a therapeutic target in metastasis, particularly brain metastasis, from breast and lung cancers.
• Dorothy Sipkins, MD, PhD, and her laboratory identified how breast cancer cells spread to the leptomeninges of the brain and spine though the bone marrow and blood vessels. The mechanism involves a receptor, integrin alpha6, and laminin surrounding the blood vessels, which prove as markers and potential therapeutic targets against leptomeningeal metastasis.
• Scott Floyd, MD, PhD and Zachary Reitman, MD, PhD, are radiation oncologists whose laboratory research focuses on the effects and therapeutic uses of radiation in both cancer cells and normal cells in the brain. Most recently, they have been studying FLASH, a new approach to radiation involving high doses of radiation delivered as fast bursts.
• Christopher Lascola, MD, PhD is a neuroradiologist and inventor of a novel theranostic, an agent that can both assist with diagnosis (a diagnostic) while also treating (therapeutic) cancer cells in the brain. The novel agent, Ascorbate megmlumine, is a derivative of Vitamin C and works to sensitize cancer cells to both chemotherapy and radiation treatments.

Clinical Research

The DCBSM offers a broad range of clini­cal trials examining new treatment approaches for patients with brain and spine metastasis. Many of the studies at Duke are open exclusively to this patient population, which has traditionally had few options at other locations. Some of the trials involve novel agents that are being evaluated for the first time in humans (Phase 1 trials) or specifically in patients with brain or spine metastasis. Other studies are bringing bench discoveries from Duke labs to patients in the clinic.

Beyond clinical trials, the team is actively engaging in research that could lead to practice-changing results. For patients with spine metastasis, a research registry led by Rory Goodwin, MD, PhD, catalogs data on tumor genetics, treatment, and patient-reported outcomes related to quality of life. This registry helps develop and answer research questions, includ­ing those that directly address patient concerns.

Laura Alder, MD, is a medical oncologist leading a large data study, CNS PATTERN, around targeted therapies and outcomes in non-small cell lung cancer brain metastasis. Given the large number of targeted therapies that have received FDA approval in recent years, a current comparative assessment of outcomes is needed in this patient population.

Carey Anders, MD and Anoop Patel, MD, both lead projects to sequence the genes of banked brain tumors, including brain metastases from breast cancer and melanoma, to better understand similarities and dif­ferences among metastases arising from different types of primary cancer. Amongst other benefits, such work will help to reveal optimal treatment regimens and the likelihood of a treatment response.

Dr. Anders also spearheaded and now leads CIMARa, an international network of multidisciplinary researchers and clinicians with the mission of improving outcomes for patients with brain metastases.

Clinical Care

Duke offers some of the most advanced surgeries and treatments, even for pa­tients who may have been told they are out of such options, through a multidisciplinary team-based approach focused on the individual patient:

• A Multidisciplinary Team: Specialists from neurosurgery, medical oncology, radiation oncology, neuroradiology, neuro-oncology and palliative care all work together seamlessly to design cutting edge treatment plans, tailored to each patient. Such individualized care is meant to deliver the best possible outcome while always still honoring the values and goals of patients. At weekly tumor board meetings, providers pool their knowledge to arrive at the very best combination of treatments personalized for each patient. Patients can meet with providers from multiple specialties on the same day, and are guided by a nurse navigator throughout their care journey.
• Transformative treatments and technologies: Duke is a leading site nationally for some of the latest treatment approaches across surgery, radiation therapy, and systemic therapy:
  • Laser interstitial thermal therapy (LITT)
  • Advanced stereotactic radiosurgery (SRS) techniques
  • Novel systemic therapies
• Caring for the Whole Patient: While the DCBSM team is one of the best in the world at providing cancer care, it is the person receiving that care that remains our primary concern. We work to understand our patients and their goals, always keeping the patient experience as central to what we do. As examples:
  • Palliative care providers are an integrated part of each patient’s team, offering a range of services, from pain relief to end-of-life planning.
  • New patients can see all members of their team in one day.
  • New-patient coordinators and nurse navigators coordinate care for patients.