Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)

 

Chemotherapy for Brain Metastases: More Helpful than It's Given Credit For
Author
Howard (Jack) West, MD

There's a general concept out there that chemo is ineffective in treating brain metastases, and in fact, I've mentioned it in some comments here in the past. The reasoning behind this is that we know there's a blood-brain barrier, and we've presumed that chemo is blocked from crossing it. But when CT or MRI scans are done with IV contrast, it often collects in brain metastases, and there's also often edema around brain metastases: these observations suggest that the blood vessels around brain mets may be disrupted. One study, for instance, showed that in patients who received chemo before surgery, cisplatin concentrations in brain metastases were the same as the levels in tumors outside of the brain (abstract here).

But the more important issue is that in the studies that have actually looked at responses of brain metastases in patients who received chemotherapy and not radiation. In a series of trials that actually directly compared responses of chemo inside and outside of the brain, the response rates in the brain were very similar to the response rates elsewhere in the body. For instance, an Italian study by Crino and colleages (abstract here) included patients with brain metastases (15-17% in the two chemo arms being compared) and found response rates of 39-41% of the brain metastases, actually higher than the response rate outside of the brain. Another interesting trial by Robinet and colleagues from France directly tested whether it helped to give early whole brain radiotherapy (WBRT) with chemo compared with starting with chemo alone, enrolling 176 patients with previously untreated lung cancer with brain metastases to early or delayed WBRT along with cisplatin/navelbine chemo (paper here). They found that the response rate in the brain to chemo alone, 27%, was not significantly different from the response rate to chemo with WBRT, 33%. The investigators also found that survival was just as good if you started with chemo and held off on WBRT initially.

In truth, this would represent a change from my typical practice and the approach that most oncologists follow, based largely on the old teaching, not supported by the trials, that chemo isn't up to the task of treating brain metastases. But given the reluctance of many patients to undergo WBRT, at least without a definite need for it if chemo can provide comparable results without it, it may be worth revising our treatment approaches to get in step with the evidence.

Next Previous link

Previous PostNext Post

Related Content

Image
Clinical Trials Storytelling 2025
Article
GRACE is pleased to introduce three amazing individuals participating in the 2024-25 GRACE Clinical Trials Experiences Storytelling Program
Article
Imagine your body's defense system, the lymphatic system, suddenly turning against you. This is the reality for those facing lymphoma, a cancer of the immune system's crucial network. This article delves into the complexities of lymphoma, exploring its various forms, from the aggressive to the indolent, and examining the latest breakthroughs in treatment, including the groundbreaking POLARIX trial and cutting-edge therapies for relapsed cases. Whether you're a patient, a loved one, or simply curious about this complex disease, this comprehensive overview will provide valuable insights into the current state of lymphoma care and the promising future of research.
Image
Melanoma Video Library
Video
In these videos, Dr. Autumn Starnes gives an overview of melanoma's prevalence and risk factors. She also discusses the ABCDE method of self-screening for skin cancer, common misconceptions regarding people of color, and melanoma, and how a person can lower their risk of developing melanoma, among other relevant topics regarding melanoma.  To watch the complete playlist, click here. 

Forum Discussions

Can SCLC also be treated with targeted therapy?

Hi amitchouhan,

Welcome to Grace. At this time, there aren't any targeted therapies to treat SCLC, but there are new treatments. Check out our latest OncTalk webinar from December. The last...

I was searching for this, Thank you so much for the info.

Glad to help.  FYI, I just edited the link, which has the agenda and links to oncologists' bios. Plus, the link is also on our home page, https://cancergrace.org/

Hope to see...

Recent Comments

JOIN THE CONVERSATION
Glad to help.  FYI, I just…
By JanineT GRACE … on
I was searching for this,…
By LilahStapleton on
Hi and welcome.  I'm sorry…
By JanineT GRACE … on
Hi amitchouhan,

Welcome to…
By JanineT GRACE … on