WCLC 2025 - Posters & ePosters-EP.03.10 Evaluating the Role of the Blood-Brain Barrier in Intracranial Response Rates for Metastatic Lung Cancer

EP.03.10 Evaluating the Role of the Blood-Brain Barrier in Intracranial Response Rates for Metastatic Lung Cancer

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This study by Tsu-Yu Unice Chang from The Ottawa Hospital investigates the role of the blood-brain barrier (BBB) in determining intracranial response rates to systemic therapies in lung cancer patients with brain metastases. Lung cancer is a leading cause of brain metastases, and traditionally, drug penetration into the brain has been considered limited due to the BBB, which often influences clinical trial eligibility and drug development strategies emphasizing brain activity.<br /><br />The hypothesis tested was that there is no significant difference between intracranial (within the brain) and extracranial (outside the brain) response rates, suggesting the brain should not be treated as a privileged or separate therapeutic site. To explore this, a literature review was conducted assessing BBB permeability of drugs used in small cell and non-small cell lung cancer, categorizing drugs by their BBB penetration levels from none to excellent. Additionally, intracranial response rates from 31 prospective and retrospective studies were collected along with extracranial and overall response rates where available.<br /><br />The results indicated that, across different drug classes, therapy lines, and predicted BBB permeability categories, systemic therapies showed comparable intracranial response rates to those seen extracranially or overall. This suggests that the BBB’s role in limiting drug efficacy in brain metastases may be less significant than previously assumed, likely due to BBB disruption caused by brain metastases themselves.<br /><br />The study concludes that drug design and clinical trial eligibility criteria should place less emphasis on BBB permeability. Furthermore, patients with brain metastases should not be routinely excluded from clinical trials, potentially broadening therapeutic options and improving outcomes for this population.

Asset Subtitle

Tsu-Yu Unice Chang

Meta Tag

Speaker Tsu-Yu Unice Chang

Topic Tumor Biology – Translational Biology

Keywords

blood-brain barrier

intracranial response

extracranial response

lung cancer

brain metastases

systemic therapies

drug permeability

clinical trial eligibility

small cell lung cancer

non-small cell lung cancer