tbuckley/cabot-search huggingface dataset:
Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study
Authors: Chiara Robba, Francesca Graziano, Paola Rebora, Francesca Elli, Carlo Giussani, Mauro Oddo, Geert Meyfroidt, Raimund Helbok, Fabio S Taccone, Lara Prisco, Jean-Louis Vincent, Jose I Suarez, Nino Stocchetti, Giuseppe Citerio, M. Abdelaty, S. Abed Maillard, H. Ahmed, L. Albrecht, A. Alsudani, E.D. Amundarain, S. Anand, J.B. Andersen, M. Anglada, Y Arabi, I. Aragao, M.D. Arias Verdu, K. Asehnoune, F. Assunção, G. Audibert, R. Badenes, T. Bajracharya, P. Banco, D. Batista, E. Bertellini, H. Berty Gutiérrez, G. Besch, P. Biston, A. Blandino Ortiz, V. Blazquez, S. Bloria, C. Bonetti, P. Bresil, I. Brunetti, V. Buldini, A. Caillard, I. Calamai, M. Carbonara, A. Caricato, M.C. Casadio, M. Casanova, P. Cavaleiro, M. Celaya Lopez, C.Y. Chan, R. Chauhan, R. Cinotti, L. Corral, A. Cortegiani, A. Cotoia, I.A. Crippa, V. Davidovich, S. Del Bianco, C. Diakaki, J. Dibu, A. Dimoula, G. Domeniconi, L.J.Y. Dominguez, N. Dovbysh, P. Duque, H.S. Eddelien, A. Efthymiou, T. Egmose Larsen, M. Elhadi, E. Favre Eva, M. Fencl, P. Forjan, R. Freitas, K. Fuest, M. Fumale, C. Gakuba, L. Galarza, M.F. García, G.A. Gasca López, C. Gelormini, A. Gempeler, A. Giannopoulos, M.E. Giménez, A. Giugni, D. Glorieux, M.I. Gonzalez Perez, P. Gradisek, M. Grandis, D. Griesdale, A. Gritsan, S. Grotheer, D. Gupta, E.D. Hallt, C. Hawthorne, R. Helbok, M.O. Holm, C. Iasonidou, O. Idowu, E. Ioannoni, A. Izzi, M. Jibaja, P. Kafle, D.H. Kandamby, M.M. Khan, S. Khomiakov, B. Kilapong, J. Kletecka, K. Kojder, A. Kolias, E. Kontoudaki, G. Koukoulitsios, N. Kovac, S. Kozar, S.M. Krieg, P. Kurtz, G. Kyriazopoulos, M. Lamperti, P. Lavicka, L. Lencastre, M. Levin, R. Lightfoot, A. Lindner, P. López Ojeda, A. Lores, M. Lucca, A. Luthra, F. Magni, B. Majholm, D. Makris, F. Maldonado, A. Marudi, S. Maskey, L. Mebis, J.H. Mejia-Mantilla, R. Mendoza, N. Milivojevic, J.P. Miroz, B. Monleon, J.M. Montes, P. Morelli, A. Motta, E. Mouloudi, S. Muehlschlegel, S.A. Ñamendys Silva, G. Nardai, K. Nilam, D. Olson, A. Ozair, C. Pacheco, J. Padilla Juan, E. Palli, N. Panda, N. Pantelas, L. Pariente, D. Pearson, R. Pérez-Araos, E. Picetti, J.L. Pinedo Portilla, B. Pons, F. Pozzi, E. Provaznikova, M.C. Quartarone, H. Quintard, L. Rajbanshi, M. Reade, S.F. Ribaric, A. Rigamonti, L.L. Rivera, J. Roberts, Y.B. Roka, O. Sabelnikovs, H. Sapra, S.J. Schaller, M. Sekhon, W. Sellami, I. Seppelt, A. Serrano, K. Sharma, G.S. Shrestha, H.P. Shum, S. Silva, M. Simoes, S. Sivakumar, R. Siviter, J. Skola, M. Škoti, M. Smitt, R. Soley, R. Sonneville, A. Soragni, B. Soyer, V. Spatenkova, E.E. Stamou, E. Stival, Z. Olson, K. Tánczos, C. Thompson, J. Thomsen, S. Tsikriki, S. Van De Velde, W. Videtta, F. Villa, K. Vrbica, C. Vrettou, H. Westy Hoffmeyer, S. Wolf, S. Wolf, S. Yasin Wayhs, S.M. Zerbi
Journal: The Lancet Neurology (2021)
Disruptions to U.S. medical oncology care during the COVID-19 Pandemic: CancerLinQ Discovery (CLQD) analysis.
Authors: Abdul-Rahman Jazieh, Mark Riffon, Jennifer C. King, Gabrielle Betty Rocque, Electra D. Paskett, Danielle M. Potter
Journal: Journal of Clinical Oncology (2021)

6547 Background: The COVID-19 pandemic disrupted all facets of healthcare delivery including cancer care. This study evaluates the disruptions to US medical oncology practice during the pandemic in terms of number and type of patients (pts) encounters to determine the impact on continuity of patient care. Methods: We conducted a retrospective cohort analysis using the CLQD electronic health record database, containing data from 2+ million pts from all 50 states. We assessed changes in the monthly proportions of visit encounter types (in-person outpatient [IPOP] and telehealth [TE]) for new and established patients (NP and EP) with an invasive malignancy, benign or in situ neoplasm, or benign hematology diagnosis having an encounter between 1/1/2018 and 9/30/2020. Results: 781,945 pts were studied. Median age on 1/1/2018 was 64 years (IQR: 53-73), 38% were female, and 58% had an invasive malignancy. From 12/2019 to 9/2020, total monthly encounters dropped from 157,964 to 90,662. Monthly IPOP visits for NP dropped from 11.2% to 7.9%, an absolute drop of 3.3% and a relative drop of 30%; TE for NP increased by 1.1% (Table). Monthly IPOP visits for EP, as a percentage of all visits, dropped from 94.4% to 86.6% from 12/2019 to 6/2020 but rebounded to 90.4% by 9/2020. Fraction of TE increased substantially during the pandemic period reaching a peak in 6/2020 (13.8% for EP and 1.6% for NP) and decreased in 9/2020 to 9.6% and 1.1% for EP and NP, respectively. Compared to non-Hispanic patients, Hispanic patients had a larger reduction in IPOP and more TE during the study period. Percentage of monthly encounters, by type, from baseline*. Conclusions: We observed a reduction in the absolute number and monthly percentage of IPOP encounters during the COVID-19 pandemic. For EP, increases in TE does not fully compensate for reductions in IPOP. The reduction in IPOP NP encounters is particularly concerning since it was not accompanied by a compensatory increase in TE. The reduction in NP is consistent with reported pandemic-associated reductions in cancer screening and suggest a notable delay in cancer diagnoses during the pandemic. Reduction in Hispanic IPOP encounters warrants further evaluation.[Table: see text]
Nearly half of <i>TP53</i> variants are misattributed to Li-Fraumeni syndrome: A clinical evaluation of individuals with <i>TP53</i> variants detected by hereditary cancer panel assays on blood or saliva.
Authors: Alison Schwartz, Sophie Hyman, Samantha Stokes, Danielle Castillo, Jeffrey N. Weitzel, Huma Q. Rana, Judy Ellen Garber
Journal: Journal of Clinical Oncology (2021)

10501 Background: Multigene panel testing (MGPT) has identified TP53 pathogenic or likely pathogenic (P/LP) variants in patients with diverse phenotypes from no cancer to classic Li-Fraumeni syndrome (LFS). There is increasing recognition of variants at low allelic fraction (VAF) for TP53 in particular, which can be suggestive of post-zygotic mosaicism or aberrant clonal expansion (ACE), comprising clonal hematopoiesis of indeterminate potential (CHIP) or occult hematologic neoplasia. Distinguishing among these categories is essential because of widely different cancer risk and management implications for patients and their relatives. We report an evaluation of TP53 positive probands to determine germline versus somatic status from a cancer genetics clinic. Methods: We reviewed probands with TP53 P/LP variants by MGPT on blood (N = 83) or saliva (N = 1) samples from 2012-2019. Available VAFs were collected from commercial testing laboratories. Probands positive for a known familial variant, who met LFS testing criteria without indication of low VAF, or who carried the Brazil founder p.R337H variant were considered germline. For those with uncertain germline status, data was obtained from ancillary testing of family members, cultured skin fibroblasts, and other somatic benign or tumor tissues. TP53 variants were further categorized based on all available data. Results: Of the 84 probands, 28 (33%) had germline TP53 P/LP variants determined by above initial criteria; 18 (21%) were confirmed germline through ancillary testing. Seven (8%) individuals were classified as having constitutional mosaicism. In eleven (13%) individuals, the TP53 variants were consistent with ACE, in 9 (11%) with CHIP and in 2 (2%) with a hematologic malignancy (1 CLL, 1 NHL). Five (6%) cases could not be categorized despite ancillary testing. Fifteen (18%) probands declined any further workup. Conclusions: A TP53 P/LP variant found on peripheral blood or saliva MGPT does not always originate in the germline. In a clinical cancer genetics cohort, only 54% of patients had TP53 P/LP germline variants; these patients plus those with constitutional mosaicism (8%) require intensified surveillance. Assessment of VAF, family member testing, and analysis of TP53 in cultured fibroblasts or other tissue samples may distinguish germline and constitutional mosaic variants from the ACE spectrum. Expanding use of MGPT will increase this clinical challenge, which may motivate the modification of lab reports to include VAF and possible non-germline explanations. The findings of this study support a framework of multiple strategies to discern true constitutional status of a TP53 P/LP variant.
Scapulothoracic Articulation Disorders on 99mTc-MDP Bone Scintigraphy
Authors: Connor Crowley, William J. Rieter
Journal: Clinical Nuclear Medicine (2021)

Abstract Disorders of the scapulothoracic articulation can cause significant pain, as well as an audible “snapping” or crepitus in advanced cases. Although radiography, CT, and MRI are used in the diagnosis of these conditions, little is known about their manifestations on nuclear imaging. We present a case of symmetric uptake at the inferior scapulothoracic articulations mimicking metastatic disease on a staging bone scan. Recognition of this pattern of activity is not only important to accurately exclude malignancy, but also to aid referring providers in addressing potential causes of patient morbidity.
Nivolumab plus cabozantinib in patients with non-clear cell renal cell carcinoma: Results of a phase 2 trial.
Authors: Chung-Han Lee, Martin H Voss, Maria Isabel Carlo, Ying-Bei Chen, Eduard Reznik, Andrea Knezevic, Robert A Lefkowitz, Natalie Shapnik, Diana Tassone, Chloe Dadoun, Neil J. Shah, Colette Ngozi Owens, Deaglan Joseph McHugh, David Henry Aggen, Andrew Leonard Laccetti, Ritesh Kotecha, Darren R. Feldman, Robert J. Motzer
Journal: Journal of Clinical Oncology (2021)

4509 Background: Cabozantinib plus nivolumab (CaboNivo) improved objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) over sunitinib in a phase 3 trial for metastatic clear cell renal cell carcinoma (RCC). (Choueiri, abstract 6960, ESMO 2020) We report the results of a phase 2 trial of CaboNivo in patients (pts) with non-clear cell RCC. Methods: Pts had advanced non-clear cell RCC, 0 or 1 prior systemic therapies excluding prior immune checkpoint inhibitors, and measurable disease by RECIST. Cabo 40 mg/day plus Nivo 240 mg every 2 weeks or 480 mg every 4 weeks was given across two cohorts. Cohort 1: papillary, unclassified, or translocation associated RCC; Cohort 2: chromophobe RCC. The primary endpoint was ORR by RECIST; secondary endpoints included PFS, OS, and safety. Cohort 1 was a single stage design that met its primary endpoint and was expanded to produce more precise estimates of ORR. Cohort 2 was a Simon two-stage design that closed early for lack of efficacy. Correlative analyses by next generation sequencing were performed and to be presented. Results: A total of 40 pts were treated in Cohort 1, and 7 pts were treated in Cohort 2 (data cutoff: Jan 20, 2021). Median follow up time was 13.1 months (range 2.2 – 28.6). In Cohort 1, 26 (65%) pts were previously untreated, and 14 (35%) pts had 1 prior line: 10 (25%) received prior VEGF-targeted therapy and 8 (20%) received prior mTOR-targeted therapy. ORR for Cohort 1 was 48% (95% CI 31.5–63.9; Table). Median PFS was 12.5 months (95% CI 6.3–16.4) and median OS was 28 months (95% CI 16.3–NE). No responses were seen among 7 patients in Cohort 2 with chromophobe histology (Table). Grade 3/4 treatment emergent adverse events were consistent with that reported in the phase 3 trial; Grade 3/4 AST and ALT were 9% and 15%, respectively. Cabozantinib and nivolumab were discontinued due to toxicity in 17% and 19% of pts, respectively. Conclusions: CaboNivo had an acceptable safety profile and showed promising efficacy in metastatic non-clear cell RCC pts with papillary, unclassified, or translocation associated histologies whereas activity in patients with chromophobe RCC was limited. Clinical trial information: NCT03635892. [Table: see text]
Clinical and immunological allergy assessment in cancer patients.
Authors: Bruno Gustavo Muzzi Carvalho Carneiro, Andy Petroianu, Jose Augusto Nogueira Machado, Paula Martins Ferreira dos Anjos, Fabiana Rocha da Silva, Luiz Ronaldo Alberti, Vivian Resende, Sofia Candia Barrientos
Journal: Journal of Clinical Oncology (2021)

e15021 Background: Cancer is associated with immunodeficiency, while allergies result from immune system hyperactivity mediated by cytokines and immunoglobulins. The purpose of this study was to determine the relationship between immune environment of specific cancers and allergies, emphasizing cytokines related to Th1 and Th2 responses associated with IgE. Methods: 80 adults were distributed into two groups: control (n = 20) and cancer (n = 60), distributed in three subgroups (n = 20), head and neck, stomach, and prostate cancers. This study considered cytokine deviation in Th1 (IL-2) response to Th2 (IL-4), anti-inflammatory, pro-inflammatory, or regulatory profile regarding both IgE levels and reported allergies, by means of clinical manifestations and IgE, IL-1β, IL-2, IL-4, IL-17, and TGF-β serum concentration. Results: Clinically allergies were observed in 50% of the control group and in 20% of the cancer group (p = 0.01). IL-2 cytokine and TGF-β concentrations were higher in the patients with cancer as compared to the control (p &lt; 0.005). However, there were IL-4, IL-17, and IL-1β decreases in the patients with cancer (p &lt; 0.05). No correlation was observed between the cytokines studied and IgE and clinically proven allergies in both investigated groups. Conclusions: There was an inverse association between cancer and clinical allergy manifestations. In head and neck, stomach, and prostate cancers, an immunosuppressive serum tumor environment was predominant. Cytokine deviation in the Th1 response to Th2 in relation to IgE was not identified. No correlation was found between clinically proved allergies and immunity markers related to the same allergens.
Matched therapies for advanced gastric cancer based on genotype: A real-world study in China.
Authors: Qin Liu, Ju Yang, Nandie Wu, Song Liu, Yipeng Zhang, Hui Chen, Xiaochen Zhao, Yuezong Bai, Baorui Liu, Jia Wei
Journal: Journal of Clinical Oncology (2021)

e16098 Background: Systemic therapy options for patients with advanced gastric cancer (GC) are limited. We here presented the efficacy results for advanced GC patients matched to targeted therapies or immunotherapies based on the identification of tumor tissue genotypes. Methods: We selected 30 patients diagnosed between 2014 and 2020 with advanced GC at Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School identified with actionable alterations and received ≥1 matched therapies. Tumor biopsy specimens from the patients were analyzed using NGS and/or selected immunohistochemistry and fluorescence in situ hybridization. Results: In these 30 patients, median age at diagnosis was 63 years (range 28-83) and 6 (20%) were female. In total, 11 (37%) harbored c-MET amplification/overexpression (received savolitinib or crizotinib, cohort A), 9 (30%) harbored HER2 mutation/overexpression (received RC48-ADC or trastuzumab, cohort B), 6 (20%) dMMR/MSI-H/TMB-H (received sintilimab, pembrolizumab, tislelizumab or nivolumab, combined with antivascular or not, cohort C), 2 (7%) KIT mutation/amplification (received imatinib or anlotinib, cohort D), 1 (3%) BRAF V600E mutation (received vemurafenib, cohort E) and 1 (3%) EGFR mutation (received afatinib, cohort F). Except for three patients in cohort C, all patients received at least one previous line systemic therapy. In cohort A, three of 11 patients had an objective response (1 complete response and 2 partial responses, objective response rate (ORR) 27%), disease control rate (DCR) was 45%, median progression-free survival (mPFS) was 2.1 months, and median overall survival (mOS) was 3.7 months. In cohort B, ORR was 44% (4/9), DCR was 78% (7/9), mPFS and mOS was 3.1 months and 5.5 months, respectively. In cohort C, ORR was 17% (1/6), DCR was 67% (4/6), mPFS and mOS was 1.9 months and 6.8 months, respectively. In cohort D, no patient had objective response or disease control. In cohort E, the one patient had PR. Stable disease was observed in the patient in cohort F. In all cohorts, ORR was 30% (9/30), DCR was 60% (18/30), mPFS and mOS was 2.7 months and 5.8 months, respectively. Conclusions: Overall, 30 patients with advanced GC were treated with matched therapies according to specific genotype. These real-world outcomes suggested that matched therapies for advanced GC has promising efficacy, supporting the adoption of genotyping in treatment determination.
Phase II study of combining immunotherapy and pulsed low dose rate radiotherapy for abdominal metastasis of gastric cancer.
Authors: Yang Yang, Jing Yan, Juan Liu, Shuangshuang Li, Shanbao Gao, Jia Wei, Baorui Liu
Journal: Journal of Clinical Oncology (2021)

e16099 Background: Immune-mediated responses against tumor antigens by checkpoint inhibitors (CPIs) may be enhanced by radiotherapy and the combination may hold therapeutic promise. Pulsed low dose rate radiotherapy (PLDR) is an effective strategy for abdominal tumor by taking advantage of low dose hyper-radiosensitivity with maximizing tumor response and minimizing adverse events by radiotherapy. In this phase II study, we prospectively analyzed the response and adverse events of the combination strategy of CPIs and PLDR for abdominal metastasis of gastric cancer. Methods: Eligibility criteria included pathologically confirmed advanced gastric adenocarcinoma with abdominal metastasis. Patients received XELOX regimen chemotherapy, anti-PD-1 toripalimab, and PLDR for abdominal metastasis, prescription dose was 50-56Gy/25-28f. The primary endpoint was objective response rate (ORR) and safety. Secondary endpoints were regional response rate (RRR) and regional controlled rate (RCR) for radiotherapy target tumor, progression-free survival (PFS), and overall survival (OS). Results: Between November 2018 and June 2020, 24 patients were enrolled and included in the efficacy analysis. 13 of them were first line therapy, and 11 of them were second line therapy. The ORR was 70.8% and the combination regimen were tolerable. The RRR was 83.3% and the RCR was 95.8%. The median PFS was 11.1 months and the median OS was not yet reached. Conclusions: In this phase II clinical trial, the combination of Immunotherapy and radiotherapy provided good response and toleration for abdominal metastasis of gastric cancer. It suggested clinical efficacy of this regimen in patients with advanced gastric cancer. Clinical trial information: NCT03061162.
Prognostic value of SUVmax on FDG-PET/CT before and after stereotactic body radiotherapy (SBRT) on recurrence and survival in early-stage non-small cell lung cancer (NSCLC).
Authors: Saarang Deshpande, Tarun Kanti Podder, Yuxia Zhang, Yiran Zheng, William Grubb, Michael Kharouta, Philip Aaron Linden, Tithi Biswas
Journal: Journal of Clinical Oncology (2021)

8539 Background: Stereotactic body radiotherapy (SBRT) is the standard of care in medically inoperable early-stage non-small cell lung cancer (NSCLC). Assessment of FDG-PET/CT before and after SBRT may stratify risk of disease recurrence and survival outcomes. Methods: Patients with T1-2N0M0 NSCLC who underwent PET/CT prior to SBRT (50-60 Gy over 3-5 fractions) between 2012 and 2019 were retrospectively identified. Pre-SBRT SUVmax and change in SUVmax at 3 and 6 months after SBRT were assessed as predictors of local control (LC), progression-free survival (PFS), and overall survival (OS). Optimal cutoff points for comparison were determined by receiver operator characteristic (ROC) analysis. Survival analyses were performed with Kaplan-Meier estimates with log rank testing, and Cox proportional hazards models including age, sex, T stage, histology, and performance status. Results: Out of 163 patients identified, 71 (43.6%) underwent repeat PET/CT within 6 months of SBRT completion. Median follow-up was 19 months (range 1 – 94 months). For the whole cohort, 1-year and 2-year LC, PFS, and OS were 95.0% and 80.3%, 75.9% and 47.7%, and 87.1% and 67.0%, respectively. Pre-SBRT SUVmax greater than 12.3 had an aHR of 2.80 (95% CI 1.3 – 6.2, p = 0.011) for PFS. A cutpoint of 12.6 for pre-SBRT SUVmax had an aHR of 3.00 (95% CI 1.6 – 5.8, p = 0.003) for OS. Pre-SBRT SUVmax did not significantly predict LC. A 3-month SUVmax decrease of at least 45% was associated with improved LC (aHR = 0.15, 95% CI 0.02 – 0.91, p = 0.018). At 6 months following SBRT, a cutoff point of a 53% decrease in SUVmax was associated with better LC (p = 0.038). Change in SUVmax was not significantly associated with PFS or OS at either time point. Performance status significantly predicted PFS and OS in all models. No other factors were significant. Conclusions: Pre-treatment SUVmax cutoffs can predict PFS and OS in early-stage NSCLC. At both the 3- and 6-month time points following SBRT, cutoff values for change in SUVmax can stratify risk of local recurrence.[Table: see text]
Presentation and management of patients with brain metastases of primary melanoma, non-small cell lung cancer, and breast cancer origin.
Authors: Yuki Kawahara, Matthew Mills, Thrisha Potluri, Matthew Fahey, Nicholas B Figura, Aixa Soyano, Iman Washington, Roberto Diaz, Daniel Eli Oliver, Hsiang-Hsuan Michael Yu, Arnold B. Etame, Michael A. Vogelbaum, Brian J. Czerniecki, John Arrington, Solmaz Sahebjam, Hatem Hussein Soliman, Peter A. J. Forsyth, Hyo S. Han, Kamran A. Ahmed
Journal: Journal of Clinical Oncology (2021)

2033 Background: As systemic therapy improves; the prevalence of brain metastases is increasing. Screening brain MRIs are currently recommended for all stage ≥ II non-small cell lung cancer (NSCLC) and stage IIIB–IV melanoma patients, but only when neurologic symptoms arise in stage IV or recurrent breast cancer (BC) patients. This study assessed the presentation and institutional outcomes treating brain metastases (BM) of BC, NSCLC, and melanoma origin. Methods: Patients with BM treated between 2014 and 2019 with primary melanoma, NSCLC, and BC were identified. Characteristics of initial BM diagnoses were retrieved from clinical chart review. Kruskal-Wallis and Pearson’s chi-square tests were used to test differences between groups. Overall survival (OS) was calculated from dates of initial BM diagnosis using the Kaplan–Meier method. Results: A total of 959 patients were identified (BC 18%, NSCLC 51%, melanoma 31%). BC patients were younger at initial presentation (BC median age: 57, NSCLC 65, melanoma 62, p&lt; 0.0001). At BM diagnosis, BC patients were more likely to have concurrent systemic metastasis (BC 77%, NSCLC 42%, melanoma 69%, p&lt; 0.0001), at least 5 BM (BC 27%, NSCLC 14%, melanoma 13%, p= 0.0004), and leptomeningeal disease (BC 23%, NSCLC 6%, melanoma 6%, p&lt; 0.0001). Patients with BC were significantly more likely to receive whole brain radiation therapy (WBRT) (BC 58%, NSCLC 37%, melanoma 22%, p&lt; 0.0001) and less likely to receive stereotactic radiation (BC 26%, NSCLC 48%, melanoma 58%, p&lt; 0.0001) following initial BM diagnosis. There were no significant differences in surgical resection between cancer types (BC 24%, NSCLC 24%, melanoma 29%, p =0.166). Median OS was shorter for BC (BC 9.9 months, NSCLC 10.3 months, melanoma 13.7 months, p= 0.0006) following BM diagnosis. Conclusions: Our institutional analysis found BC patients were more likely to be younger, present with more advanced brain disease, require WBRT, and have poorer OS than NSCLC and melanoma patients following initial brain metastasis diagnosis. This may be due in part to a lack of brain MRI screening recommendations in BC. Further investigation is needed to determine which BC patients are at sufficient risk to warrant brain MRI screening.