EXCLAIM: Exploring Combined Local and Systemic Approaches In Brain Metastasis: a Multi-cohort Randomized Phase II Study Evaluating Initial Response to Systemic Therapy and Subsequent Integration of Stereotactic Radiosurgery in Patients With Low-risk Brain Metastases and Central Nervous System-active

This study is exploring whether it is safe and effective to delay local treatment (like surgery or targeted radiation) for brain metastases (cancer that has spread to the brain) and instead start with systemic therapy (medications that travel through the whole body) first, then use precision radiation (SRS) if needed later. **You may be eligible if...** - You are 18 or older with brain metastases - A specialist team (including an oncologist, radiation oncologist, and neurosurgeon) has agreed it is safe to hold off on immediate local brain treatment - Your systemic therapy is expected to have some effect on your brain tumors - Your expected survival is more than 6 months - Your brain metastases could be treated with precision radiation (SRS) if needed **You may NOT be eligible if...** - Your brain metastases require urgent local treatment right away (e.g., causing severe symptoms) - Your overall condition is too poor for the planned therapy Talk to your doctor to see if this trial is right for you.