Brain MRI Surveillance Alone Helps Preserve Cognition in Small Cell Lung Cancer

In the phase III MAVERICK trial (SWOG S1827), 304 patients with small-cell lung cancer who had completed initial therapy without brain metastases were randomised to brain MRI surveillance alone or to MRI plus prophylactic cranial irradiation (PCI). MRI alone improved the primary endpoint, cognitive failure-free survival (HR 0.60; 90% CI 0.46–0.78; p=0.001). Overall survival did not differ in a preliminary analysis after 128 of the planned 190 deaths (HR 0.90; 90% CI 0.67–1.20), and brain metastasis-free survival was likewise not significantly different (HR 1.25; 90% CI 0.95–1.66). The investigators presented the data at the IASLC World Conference on Lung Cancer in Seoul on 13 September 2026 and consider them to support MRI surveillance alone as standard of care; the final survival analysis and a peer-reviewed publication are still outstanding.