Nov. 25, 2025
Mayo Clinic routinely incorporates molecular data into the management of brain metastases. The patient-specific approach can potentially spare select individuals from undergoing additional surgery or radiation therapy.
"Molecularly driven treatment is increasing in every aspect of neuro-oncology, including in the management of brain metastases," says Ian F. Parney, M.D., Ph.D., a neurosurgeon at Mayo Clinic in Rochester, Minnesota. "Mayo Clinic is leading the charge for getting molecular information on a routine basis, and it is important in deciding the management of patients with brain metastases."
Brain metastases are the most common central nervous system tumor. About 20% of people with cancer develop brain metastases. Standard treatment involves surgical resection and radiation therapy, particularly Gamma Knife radiosurgery. But systemic therapies that target specific mutations and can cross the blood-brain barrier are becoming available.
At Mayo Clinic, biopsies of primary tumors provide molecular data that can guide treatment of the primary cancer and future metastases. For example, patients with non-small cell lung carcinomas whose tumors have mutations in the AKT gene might benefit from new drugs that target the AKT pathway. Melanoma cells with the BRAF mutation also are targetable.
"There's a chance that almost any type of metastasis to the brain has a molecular subtype that may be amenable to a targeted therapy," Dr. Parney says. "Not every patient has a targetable mutation. But getting that molecular information is key to help decide the optimal treatment. A subset of patients with brain metastases might be able to have purely systemic therapy."
Incorporating molecular data into patient care requires a multidisciplinary team. Mayo Clinic's multispecialty Brain Metastases Specialty Group includes medical oncologists, neuro-oncologists, radiation oncologists, neurosurgeons, pathologists and radiologists. "We meet daily to talk about what the best treatment might be for an individual," Dr. Parney says.
Immunotherapies are another potential option, for tumors with certain immunologic molecular profiles. "Immunotherapies can cross the blood-brain barrier and have effects on brain metastases," Dr. Parney says.
Immunotherapy might be combined with Gamma Knife radiosurgery. "Immunotherapy primes the patient's immune system to respond to the tumor. Gamma Knife radiosurgery will cause a focal tumor to release tumor proteins into the immune system — which has been primed to kill cancer cells," Dr. Parney says.
Personalized care is a cornerstone of Mayo Clinic's approach to cancer care. "We avoid the knee-jerk reaction that 'everybody needs surgery' or 'everybody needs radiation,' " Dr. Parney says. "Our team works in an informed way. That patient-centered, multidisciplinary approach, with a very deep bench of expertise, really makes a difference."
For more information
Brain Metastases Specialty Group. Mayo Clinic.
Refer a patient to Mayo Clinic.