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Systemic therapy for lung cancer brain metastases: a rationale for clinical trials
1Department of Thoracic, Head & Neck Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. ywoh@mdanderson.org
Abstract:
Despite the high prevalence of brain metastases in patients with metastatic lung cancer, these patients have been excluded from enrollment in clinical trials of new therapeutic drugs. The reasons for exclusion have centered on concerns that the blood-brain barrier may impede drug delivery into brain metastases, that brain metastases confer a dismal survival for metastatic lung cancer patients, and that brain metastases carry risk for cerebrovascular hemorrhage. A focused, updated review of these issues, however, clearly shows that these particular concerns are unwarranted. An extensive review of clinical trials on the efficacy of chemotherapeutic agents against lung cancer brain metastases is also provided. This collective information describes an area in need of therapeutic development and supports an initiative to evaluate novel targeted therapies for lung cancer brain metastases.
Insights
Patients with lung cancer brain metastases can be included in clinical trials. Concerns about the blood-brain barrier, survival, and hemorrhage risk are unwarranted, supporting new targeted therapy evaluations.
Area of Science:
- Oncology
- Neurology
- Clinical Trials
Background:
- Brain metastases are common in metastatic lung cancer.
- Patients with brain metastases are often excluded from clinical trials.
- Exclusion is based on concerns about drug delivery, survival, and hemorrhage.
Purpose of the Study:
- To review the validity of excluding lung cancer patients with brain metastases from clinical trials.
- To assess the efficacy of existing chemotherapies against lung cancer brain metastases.
- To advocate for the evaluation of novel targeted therapies for this patient group.
Main Methods:
- Literature review of clinical trials concerning lung cancer brain metastases.
- Analysis of concerns regarding blood-brain barrier penetration, survival rates, and cerebrovascular hemorrhage.
- Review of chemotherapy efficacy data for lung cancer brain metastases.
Main Results:
- Concerns justifying exclusion from clinical trials are not supported by current evidence.
- Existing chemotherapy data for lung cancer brain metastases is limited.
- There is a clear need for therapeutic development in this area.
Conclusions:
- Current concerns regarding the inclusion of lung cancer patients with brain metastases in clinical trials are unwarranted.
- Novel targeted therapies should be evaluated for efficacy in treating lung cancer brain metastases.
- Increased clinical trial participation for these patients is crucial for advancing treatment options.
