Alireza Mansouri: ACHIEVE Trial Explores Targeted Therapy for Brain Metastases in Lung Cancer
Alireza Mansouri, Associate Professor at Penn State Health, shared a post on LinkedIn:
“Brain metastases in lung cancer: a frontier long ignored.
Up to 40% of patients with EGFR-mutant non-small cell lung cancer (NSCLC) develop brain metastases. Yet historically, these patients are excluded from clinical trials—due to concerns about poor prognosis and the complexities of CNS disease.
But the ACHIEVE trial flips that narrative. This Phase 2 study tested high-dose aumolertinib, an oral EGFR inhibitor that penetrates the blood-brain barrier.
No radiation. No surgery. Just a pill․
Here’s what makes it groundbreaking:
- All patients had untreated brain metastases at baseline
- Prior radiosurgery was allowed, but the tumors that had radiosurgery were not counted in the final evaluation. Only untreated or progressed lesions were evaluated
- Whole brain radiation was explicitly excluded
- NOTE – Cause of death wasn’t broken down by neurologic vs systemic—but intracranial control was impressive – At 12 months, 72% of participants did not see any progression of brain tumors that were present at baseline.
- NOTE – there is no reporting on the rate of salvage radiation or surgery for lesions that did progress.
Why this matters:
This trial shows that targeted systemic therapy can control brain metastases without local interventions. It opens the door to more inclusive trial designs and better outcomes for patients previously left behind.
It is important to note that this was a Phase 2 study, meaning that a larger Phase 3 study may be needed, comparing to other established treatments.
Our team previously reviewed ongoing investigations.
See attached Table to see how this trial compares with the MARIPOSA and FLAURA2 trials.”
Title: Stereotactic radiosurgery for patients with brain metastases: current principles, expanding indications and opportunities for multidisciplinary care
Journal: Nature Reviews Clinical Oncology
Authors: Alireza Mansouri, Ahmad Ozair, Debarati Bhanja, Hannah Wilding, Elad Mashiach, Waqas Haque, Nicholas Mikolajewicz, Leonardo de Macedo Filho, Sean S. Mahase, Mitchell Machtay, Philippe Metellus, Frédéric Dhermain, Jason Sheehan, Douglas Kondziolka, L. Dade Lunsford, Ajay Niranjan, Giuseppe Minniti, Jing Li, Steven N. Kalkanis, Patrick Y. Wen, Rupesh Kotecha, Michael W. McDermott, Chetan Bettegowda, Graeme F. Woodworth, Paul D. Brown, Arjun Sahgal, Manmeet S. Ahluwalia
More posts featuring Alireza Mansouri on OncoDaily.
-
Challenging the Status Quo in Colorectal Cancer 2024
December 6-8, 2024
-
ESMO 2024 Congress
September 13-17, 2024
-
ASCO Annual Meeting
May 30 - June 4, 2024
-
Yvonne Award 2024
May 31, 2024
-
OncoThon 2024, Online
Feb. 15, 2024
-
Global Summit on War & Cancer 2023, Online
Dec. 14-16, 2023