According to the National Institutes of Health (NIH), an estimated 623,405 people in the U.S. were living with metastatic melanoma, breast, lung, prostate, bladder, or colorectal cancer in 2018. By 2025, the prevalence will increase by an estimated 11%.
While melanoma and colon cancer commonly metastasize to the brain, and prostate cancer often advances to the spine, lung and breast cancer tend to metastasize to both the brain and spine.
"An increasing number of patients need treatment for cancer-related brain or spine metastasis, and for a potentially longer continuum of care," says breast medical oncologist Rani Bansal, MD, of the Duke Cancer Institute (DCI).
The Duke Center for Brain and Spine Metastasis (DCBSM) recently expanded its services to Duke Cancer Center Raleigh, now offering a specialized multidisciplinary approach to care for patients throughout the Triangle affected by any cancer that metastasizes to the brain or spine.
DCBSM doctors and surgeons are among a handful of specialists in the country who are refining, performing, and teaching leading-edge treatments for patients with any cancer type that has metastasized to the brain or spine. The team of medical oncologists from breast, thoracic, neuro-oncologic, dermatologic, gastrointestinal, genitourinary, and gynecologic specialties offer patients more personalized, coordinated care among specialist groups.
Improving access to advanced care
"The level of care DCBSM provides is unique," says Bansal. "Patients with brain or spine metastatic disease benefit from multidisciplinary expert opinions and decisions about their best possible path forward."
The program brings together oncologists, radiation oncologists, neurosurgeons, pharmacologists, neuroradiologists, case managers, patient navigators, and additional specialists to personalize each patient’s care plan. Through formal tumor boards, the group meets regularly to review and discuss brain and spine metastasis cases across primary breast, lung, and other cancer groups.
Expanding clinical trials
As the associate director for breast cancer clinical trials, Bansal says the expanding clinical trial portfolio increases patients' access to treatment options they likely wouldn't have at other centers. "When I present a patient's case at tumor board, the team collectively reviews if they are eligible for a clinical trial."
For patients with brain and spine metastasis, this may offer more life-extending options.
"Unfortunately, many clinical trials for breast cancer exclude patients with brain or spine metastasis because of challenges with drugs entering the blood–brain barrier," Bansal says. "We're focusing on identifying treatments that can better penetrate the central nervous system."
DCI also is expanding its local thoracic oncology clinical trial portfolio with DCBSM under the research leadership of thoracic oncologist Laura Alder, MD. Alder’s clinical focus is advancing treatments for lung cancer-related brain metastasis.
To schedule a new patient with 48-hour access, or for patient appointment updates, call 1-866-DUKE-123 (866-385-3123) or fax 919-613-2361 Monday through Friday, between 8 a.m. and 4:30 p.m.
You also can email OncologyReferral@Duke.edu or use the referral form below.
Expert support through the care continuum
DCI specialists treat many patients as their primary oncologist and also support patients' established treatment teams as a secondary oncologist when another level of clinical expertise or care is needed.
"Sometimes, oncologists want another opinion on radiologic findings on the brain or spine, or they've gone through first, second, and third lines of treatment and are seeking guidance on the next best step in care," says Bansal.
"We can support at any point in a patient’s journey, from diagnosis to determining the right line of treatment, getting advanced neuroimaging, or monitoring a patient over time."