Neuro-Oncology Research Updates

A Markov model with >100,000 Monte Carlo simulations compared upfront stereotactic radiosurgery (SRS) versus hippocampal-avoidant whole-brain radiotherapy (HA-WBRT) for brain metastases from small cell lung cancer. SRS was more costly and more effective in the majority of simulations (base-case ICER $2,126.88); MRI and hospice costs, the utility decrement from HA-WBRT–related neurocognitive decline, and transition probabilities for control, recurrence, and death had the largest influence on the incremental cost-effectiveness ratio.

This systematic review identified 14 preclinical in vivo glioblastoma studies testing various STING agonists delivered by intracranial injection, hydrogels, or nanoparticles and found consistent immune effects including increased CD8+ T‑cell and NK‑cell infiltration and repolarization of tumor-associated macrophages toward pro‑inflammatory phenotypes. Several studies reported prolonged survival and occasional long‑term tumor clearance, and some demonstrated synergistic effects when STING agonists were combined with immune checkpoint blockade or radiotherapy, while authors note translational challenges related to model limitations and uncertain cell‑type–specific STING effects in the brain.

In a propensity‑matched real‑world cohort of adults with newly diagnosed metastatic EGFR‑mutant NSCLC (777 per arm), first‑line osimertinib yielded longer median overall survival than second‑generation EGFR TKIs (median 53.4 vs 33.2 months; HR 0.618). Sequential use of second‑generation TKIs followed by osimertinib achieved similar overall survival but with higher toxicity, whereas first‑line osimertinib reduced hospitalizations, ICU admissions, and severe infections and was associated with substantial health care savings despite higher drug costs; patients with brain metastases derived greater survival benefit with osimertinib (HR 0.563).