Carbo/ pem and brain mets - 1264302

Hi stacrober2,

Actually, as Dr. West has stated: "[Xalkori] probably doesn't get into the central nervous system to any meaningful degree..." - http://cancergrace.org/topic/crizotinib-after-wbr-in-treating-brain-met…

As far as the question of chemo drugs penetrating the blood brain barrier, 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

Many patients have a fear of whole brain radiation, due mostly to anecdotal evidence of WBR causing cognitive deficits. These reports have been spread across the internet, but tend to be greatly overstated: http://cancergrace.org/radiation/2010/09/13/radiation-faq-what-side-eff… It remains the treatment of choice for multiple brain mets. For a small number (~3 or fewer), targeted radiation such as gamma knife is appropriate.

JimC
Forum moderator

My (admittedly limited) sense of the responses of brain metastases to chemotherapy or a second generation ALK inhibitor is that these are transient, temporizing, and incomplete compared with the more durable benefits typically seen with radiation. I understand the aversion to brain radiation, but it beats growing brain metastases...

-Dr. West