SURVEY-CNS: A Feasibility Study of Randomising Women and Men With HER2-Positive Metastatic Breast Cancer to Central Nervous System Surveillance Versus No Surveillance (SURVEY-CNS)

SURVEY-CNS: A Feasibility Study of Randomising Women and Men With HER2-Positive Metastatic Breast Cancer to Central Nervous System Surveillance Versus No Surveilla

SURVEY-CNS is a feasibility study evaluating whether women and men with HER2-positive metastatic breast cancer can be successfully recruited and randomised to a strategy of central nervous system (CNS) magnetic resonance imaging (MRI) surveillance versus standard of care (no routine CNS surveillance).

Patients with HER2-positive metastatic breast cancer have a high risk of developing brain metastases. Brain metastases can cause significant symptoms, including headache, nausea, seizures, visual disturbance, motor dysfunction, and cognitive or psychological changes. Although new HER2-directed therapies have improved systemic disease control, CNS progression remains common and is associated with reduced quality of life and survival.

Currently, routine brain imaging is not recommended in asymptomatic patients. Brain imaging is typically performed only when neurological symptoms develop. Observational data suggest that patients diagnosed with asymptomatic brain metastases may have better outcomes than those diagnosed after symptoms occur. However, it is not known whether a surveillance strategy is feasible or acceptable to patients.

All participants in this study will undergo a baseline contrast-enhanced brain MRI. Patients without evidence of CNS metastases on the baseline scan will be randomised (1:1) to either:

CNS surveillance with repeat brain MRI at 6 and 12 months, or No routine surveillance imaging (standard of care), with imaging only if clinically indicated.

The primary objective is to determine whether more than 30% of eligible patients approached agree to undergo screening and randomisation. The study will approach up to 193 patients and will be considered feasible if 69 patients consent to screening with intent to randomise.

Secondary objectives include:

Determining the proportion of patients with previously undetected (occult) CNS metastases at baseline; Determining the incidence of occult CNS metastases during surveillance; Recording symptomatic CNS presentations; Describing management of CNS metastases, including surgery or radiotherapy. Participants will be followed for 14 months from baseline.

Study Overview

• Status: Recruiting
• Conditions: Breast Cancer; HER2-Positive Metastatic Breast Cancer
• Intervention / Treatment: Diagnostic test: Brain Magnetic Resonance Imaging (MRI) with Contrast

Detailed Description

HER2-positive metastatic breast cancer is associated with a high cumulative incidence of central nervous system metastases. Advances in systemic HER2-targeted therapies have improved extracranial disease control and overall survival; however, CNS progression remains a major cause of morbidity and mortality.

Current standard practice does not include routine CNS surveillance imaging in asymptomatic patients. Brain imaging is typically performed only following the onset of neurological symptoms. Observational registry data suggest that detection of asymptomatic brain metastases may be associated with improved survival compared with symptomatic presentation. Whether a structured surveillance approach is feasible and acceptable to patients has not been prospectively evaluated.

SURVEY-CNS is a non-CTIMP, randomised, parallel-group feasibility study conducted in Ireland in collaboration with UK centres running a parallel study under the same protocol.

All registered participants will undergo a baseline contrast-enhanced MRI of the brain. Participants with radiologically evident CNS metastases at baseline will not proceed to randomisation and will be managed according to standard clinical practice. Participants without CNS metastases will be randomised in a 1:1 ratio to:

Surveillance arm: Brain MRI at 6 months and 12 months Standard-of-care arm: No routine surveillance imaging

Randomisation will be stratified by:

Oestrogen receptor (ER) status (positive vs negative) Line of metastatic therapy (first line vs second or later)

Participants will be followed for 14 months from baseline for:

Development of radiologically detected CNS metastases Development of symptomatic CNS disease CNS-directed local therapy (surgery, stereotactic radiosurgery, whole brain radiotherapy) Changes in systemic anti-cancer therapy Survival status

The primary endpoint is feasibility, defined as the proportion of eligible patients who consent to screening and randomisation. A single-stage A'Hern design will be used. The study will halt when either 69 patients have consented or 193 patients have been approached.

Recruitment pathways will be evaluated using a structured screening log and the SEAR (Screened, Eligible, Approached, Randomised) framework to identify barriers to participation and inform planning of a future definitive trial.

This study is designed to determine whether a larger efficacy trial of CNS surveillance in HER2-positive metastatic breast cancer is practicable.

• Study Type: Interventional
• Enrollment (Estimated): 69
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Carlo Palmieri, MD, PHD; Phone Number: 018093000; Email: cpalmi@liverpool.ac.uk

Study Locations

• Ireland
  • Beaumont, Ireland
    • Recruiting
    • Beaumont RCSI Cancer Centre
    • Contact: Prof Leonie Young, PhD; Email: lyoung@rcsi.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥18 years
• Male or female
• Histologically or cytologically confirmed HER2-positive breast cancer
• Evidence of metastatic breast cancer
• Estrogen receptor (ER) positive or negative disease permitted
• Presence of visceral metastatic disease
• Receiving active HER2-directed systemic therapy
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2
• Estimated life expectancy greater than 6 months
• Ability to provide written informed consent
• Willing and able to comply with study procedures and follow-up

Exclusion Criteria:

• Prior history of brain metastases
• History or evidence of leptomeningeal carcinomatosis
• Symptoms suggestive of brain metastases at screening
• Bone-only metastatic disease
• Inability to undergo MRI scanning
• Known hypersensitivity or contraindication to MRI contrast agents that cannot - be managed per local standard of care
• Significant medical condition or laboratory abnormality that, in the opinion of - the investigator, makes participation inappropriate Inability to provide informed consent
• Deemed unsuitable for participation by the principal investigator due to clinical, mobility, or social circumstances

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CNS Surveillance; Participants undergo a baseline contrast-enhanced brain MRI. Those without radiologic evidence of CNS metastases are randomized to receive structured CNS surveillance consisting of repeat brain MRI at 6 months and 12 months after baseline. If CNS metastases are detected at any time, management is according to standard clinical practice.	Diagnostic test: Brain Magnetic Resonance Imaging (MRI) with Contrast; Contrast-enhanced MRI of the brain performed according to local institutional standards. In the surveillance arm, MRI is performed at baseline, 6 months, and 12 months. In the standard-of-care arm, MRI is performed at baseline only, with additional imaging if clinically indicated.
Active Comparator: No Routine CNS Surveillance (Standard of Care); Participants undergo a baseline contrast-enhanced brain MRI. Those without radiologic evidence of CNS metastases are randomized to no routine surveillance imaging. Subsequent brain imaging is performed only if clinically indicated based on symptoms or clinician judgment. Management of any detected CNS metastases follows standard clinical practice.	Diagnostic test: Brain Magnetic Resonance Imaging (MRI) with Contrast; Contrast-enhanced MRI of the brain performed according to local institutional standards. In the surveillance arm, MRI is performed at baseline, 6 months, and 12 months. In the standard-of-care arm, MRI is performed at baseline only, with additional imaging if clinically indicated.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Eligible Patients Consenting to Screening and Randomisation	The proportion of eligible patients approached who provide written informed consent to undergo baseline contrast-enhanced brain MRI with intent to proceed to randomisation (if no CNS metastases are detected). Feasibility will be determined using a single-stage design, with success defined as more than 30% of approached eligible patients consenting to participate.	Through recruitment completion, an average of 24 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Patients With Occult CNS Metastases at Baseline MRI	The proportion of registered participants in whom previously undiagnosed (asymptomatic) CNS metastases are detected on the baseline contrast-enhanced brain MRI prior to randomisation.	At baseline (prior to randomisation)
Proportion of Patients With Radiologically Detected CNS Metastases During Surveillance	Among randomised participants, the proportion who develop previously undiagnosed CNS metastases detected on scheduled surveillance MRI (surveillance arm) or clinically indicated imaging (standard-of-care arm).	Up to 12 months after randomisation
Proportion of Patients Developing Symptomatic CNS Disease	The proportion of participants who develop neurological symptoms attributable to CNS metastases, including headache, nausea/vomiting, seizure, visual disturbance, motor dysfunction, coordination impairment, cognitive change, or psychological disturbance.	Up to 14 months after baseline
Description of Initial Local Treatment for CNS Metastases	Among participants diagnosed with CNS metastases, the proportion receiving surgery, stereotactic radiosurgery (SRS), or whole brain radiotherapy (WBRT) as initial CNS-directed local therapy.	Up to 14 months after baseline
Systemic Anti-Cancer Therapy (SACT) Modification Following CNS Diagnosis	The proportion of participants requiring initiation, cessation, or modification of systemic anti-cancer therapy following diagnosis of CNS metastases.	Up to 14 months after baseline

Collaborators and Investigators

• Sponsor: Royal College of Surgeons, Ireland
• Collaborators: Royal Marsden NHS Foundation Trust; The Clatterbridge Cancer Centre NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2025
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2028

Study Registration Dates

• First Submitted: February 16, 2026
• First Submitted That Met QC Criteria: March 26, 2026
• First Posted (Actual): March 31, 2026

Study Record Updates

• Last Update Posted (Actual): March 31, 2026
• Last Update Submitted That Met QC Criteria: March 26, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Skin Diseases; Breast Diseases; Skin and Connective Tissue Diseases; Breast Neoplasms; Diagnostic Techniques and Procedures; Diagnosis; Tomography; Diagnostic Imaging; Magnetic Resonance Imaging
• Other Study ID Numbers: 25-46

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No