Camilo E. Fadul, MD, FAAN
Professor of Neurology, Medicine, and Neurological Surgery
In this edition of Grand Rounds in Hematology and Oncology from September 2023, Patrick M. Dillon, MD, University of Virginia Hematology & Oncology, Charlottesville, Virginia, introduces Camilo E. Fadul, MD, FAAN, Professor of Neurology, University of Virginia, Charlottesville, Virginia. In this 54-minute presentation, Dr. Fadul notes that patients with brain metastases are often excluded from clinical trials, leading to a lack of dedicated research and systemic treatment options.
Dr. Fadul highlights that while patients with brain metastases are living longer due to advances in systemic therapy, these treatments often fail to adequately address intracranial disease. Inconsistent access to advanced imaging and care, especially in underserved populations, further compounds disparities in outcomes.
To improve outcomes, Fadul advocates for a paradigm shift—from viewing brain metastases as an isolated complication to treating them as part of the systemic cancer continuum. He introduces a grading system that can stratify patients based on prognosis, helping to guide treatment intensity and goals. Moreover, he points to the promise of molecular profiling and blood-brain barrier-penetrant agents, which can personalize treatment and reduce unnecessary interventions.
Dr. Fadul also details the structure of a multidisciplinary Brain Metastases Program at the University of Virginia. This program integrates neurosurgery, radiation oncology, medical oncology, neuro-oncology, palliative care, and care coordination. This model facilitates rapid consultations and personalized care plans, improving survival and quality of life.
Dr. Fadul calls for broader inclusion of brain metastasis patients in clinical trials and more equitable access to high-quality care, stressing the importance of collaboration across specialties and institutions to advance both research and patient care.