Chemos that can cross the blood brain barrier? - 1255646

shinbo
Posts:20

Hello everyone,

Since one of the main concerns of patients on targeted therapy crizotinib is that it doesn't cross the blood brain barrier. I was wondering can any of the chemotherapies cross the blood brain barrier? Specifically anything within Carbo, Alimta, and Avastin.

Thank you

Dan

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Reply # - April 14, 2013, 07:05 PM

JimC
Posts: 2753

Hi Dan,

There's limited research on that question, since radiation tends to be the treatment of choice when possible. But Dr. West has said:

"It's not very well studied, but the idea that chemotherapy can't get into the brain because of the blood-brain barrier is oversimplified. There's actually evidence that the response rate of metastases in the brain is in the same ballpark as that of measured disease outside of the brain:

http://cancergrace.org/lung/2007/10/24/chemo-for-brain-mets/

There have been some vague hints that Alimta (pemetrexed) and Camptosar (irinotecan) may be particularly effective for brain metastases, but frankly I'd say that the amount and quality of that evidence isn't enough for me to be at all inclined to make clinical decisions on the basis of that work. There's really no meaningful work to suggest that one lung cancer treatment is significantly more effective against brain metastases compared with others." - http://cancergrace.org/forums/index.php?topic=11255.msg92631#msg92631

JimC
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Reply # - April 14, 2013, 09:06 PM

Dr West
Posts: 4735

The information that Janine and Jim provided is really as comprehensive as there is, and the only other thing I'd add is that Avastin (bevacizumab) is not generally recommended for people with untreated and/or symptomatic brain metastases from lung cancer.

Good luck.

-Dr. West

Reply # - April 17, 2013, 05:50 PM

shinbo
Posts: 20

Thank you everyone for your replies.

I'm not sure if I should create another post and risk flooding the forums but I was wondering if a biopsy were to be done, would it matter if the biopsy occurred after chemo or should the biopsy be done before chemo, or does it not make any difference?

-Daniel

Reply # - April 17, 2013, 07:40 PM

Dr West
Posts: 4735

In general, it makes the most sense to do a biopsy as recently as is feasible before the next decision is to be made. If there's tissue available from earlier, we're usually happy to use that, but molecular markers can change over time, so if a new biopsy is going to be done, it makes the most sense to do it as close to the time of clinical decision-making as possible.

-Dr. West

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