kimmek Posted September 13, 2004 Share Posted September 13, 2004 Good Morning all...I hope this day finds everyone well. I have been thinking and thinking alot about this and figured maybe someone here may know the answer. I have been told or heard that chemo does not get to or effect the brain, that being said, what prevents the cancer from spreading to the brain?? When Mom was first dx i asked her onc about the cancer spreading while she underwent the radiation and chemo and was told the chemo will kill all cancer cells during this time. OK but if it doesnt get to the brain how can chemo prevent it from spreading there?? We see the radiation doc tomorrow for moms follow up visit after finishing radiation and plan to ask her this question but until then hopefully i can gain some more insight. Thanks in advance for any and all feedback Have a blessed day Kim Quote Link to comment Share on other sites More sharing options...
TAnn Posted September 13, 2004 Share Posted September 13, 2004 Kim, I have been wondering about this too. Also, if chemo does not get to the brain, how do they explain "chemo head"? After 2 types of chemo, my memory is definately not that good. Maybe John can help us with this?? John????? TAnn Quote Link to comment Share on other sites More sharing options...
kayd Posted September 13, 2004 Share Posted September 13, 2004 The only answer I can give is the doctor told us that it is a blood barrier thing,which I sure don't understand, there is a drug called Temadar that does break that barrier, but I don't think it is very effective, My husband took it during one round of Chemo and was terribly sick, it didn't keep the mets from showing up later in his brain, he had to have WBR for 5 new small mets. KAYD Quote Link to comment Share on other sites More sharing options...
Elaine Posted September 13, 2004 Share Posted September 13, 2004 TANN, You ask a very good question--what about chemo brain? Maybe chemo cuts off some blood supply to the brain or depletes oxygen. I don't think anyone really knows. Quote Link to comment Share on other sites More sharing options...
jean44 Posted September 13, 2004 Share Posted September 13, 2004 Kim, My Dad (whom we lost Oct. 2003) had lung cancer that eventually led to mets on his brain. We were told once the mets were found that chemo will not work on the brain. My Dad ended up having the stereotactic radiation which did nothing to help the tumors in his brain. We lost him 11 months after diagnosed. You, your Mom and family are in my prayers. Jean Quote Link to comment Share on other sites More sharing options...
stand4hope Posted September 13, 2004 Share Posted September 13, 2004 Kim, We were told "some" of it (chemo) gets through, but not enough to be effective or aggressive enough to destroy the cancer cells. I don't know anything about chemo brain, but maybe enough gets through to make things a little foggy. Peggy Quote Link to comment Share on other sites More sharing options...
Snowflake Posted September 13, 2004 Share Posted September 13, 2004 My understanding of "chemo brain" is that the white matter is compromised. Gray matter would be what everyone views as brain cells, the white is the connections between the cells, the little highways for the electrical currents that are thoughts. White matter CAN be re-routed, gray matter damage is another story. From my recent readings, "chemo brain" can be successfully treated... The brain is "protected" from outside interference (i.e. medicine/chemo) with a blood/brain barrier. Cancer cells are actually body cells, so it's like a friendly fire issue or maybe view it as a traitor slipping between the lines of battle...knows the passwords and gets in to wreak havoc... That was my take on it, but then again, I'm suffering with some diminished thought patterns right now... I'm sure John would have a more technical explanation. Quote Link to comment Share on other sites More sharing options...
john Posted September 13, 2004 Share Posted September 13, 2004 Here is a good article I found immediately below. I will take some time to read through though. Topotecan is supposed to somewhat better on brain mets, but of course nothing is 100%. http://www.current-reports.com/article. ... &KeyWords= The metastatic process includes many steps: detachment from the primary tumor site, response to chemotactic factors, invasion and degradation of the ECM,2 angiogenesis, and successful growth within the target organ (1 , 2 , 3) . Despite our growing understanding of tumor progression, the molecular mechanisms of brain metastasis remain poorly understood. In part, this is because the brain is physiologically distinct from other organs by virtue of the blood-brain barrier, autoregulation of blood flow, lack of lymphatic drainage, and lack of regenerative capacity of injured neurons (1 , 3 , 4) . To metastasize to the CNS, tumor cells must adhere to the brain microvasculature, penetrate the blood-brain barrier, and grow within the brain parenchyma. Whether the pathways used are unique to the brain or common to a universal metastatic process is unknown. As Elaine, said I don't think anyone really knows yet. There is a theory that MMP-9, is involved in brain metastasis and there were trials of MMP inhibitors. I am not sure what is the newest findings on those. http://clincancerres.aacrjournals.org/c ... /5/12/4028 Quote Link to comment Share on other sites More sharing options...
kimmek Posted September 13, 2004 Author Share Posted September 13, 2004 Thanks all..I think..Now I just have more and more questions..LOL The more I learn, the more confused I become, Im just glad to know Im not the only one thinking about this, and wondering. I know when Mom was dx, there were NO brain mets, and I wonder if we did a scan today if that would still be true. I can see where the chemo will prevent mets to say the spine or liver or something. BUT what is preventing them from going to the brain. So know Im curious as to what "chemo brain" is. Mom doesnt seem to act strange or anything like that, although she was rather confused a couple of days, but I know that was from all the meds she was taking to try to feel better, and as soon as she quit taking them she was back to normal. Thanks again all, i really appreciate the time you all take to answer me questions. Kim Quote Link to comment Share on other sites More sharing options...
TAnn Posted September 13, 2004 Share Posted September 13, 2004 Kim, The best way I can explain "my" chemo-brain is that I sometimes feel a little "foggy" Sometimes I can't remember details of a conversation or my husband will ask me questions like "who sings that song......?" and when I try to think of the person, my brain just goes blank, when I know that I know the answer. So basically it makes you feel a little foggy and some light memory problems. for me that is! TAnn Quote Link to comment Share on other sites More sharing options...
MJ Posted September 13, 2004 Share Posted September 13, 2004 hi kim, my mom's onco too talked about the "blood-brain" barrier thing (i'm so un-scientific though that it's still hard to understand). i know some people have talked about pci, even for nsclc, but i don't know too much about it (you can do a general search on the site). my mom's onco told us that taxotere (sp?) does cross the blood-brain barrier, and he was initially going to give my mom low doses of that while she had wbr, but we switched to iressa because i thought that it would be easier on my mom. sadly, i guess there is really no full proof method of preventing brain mets yet, but i would suggest that if your mom has persistent headaches, dizziness, confusion etc. for more than a few days that she immediately gets a mri of her brain. the earlier that the brain mets are found, the better, especially if there is only one or two. hope that this helps. God bless, mj Quote Link to comment Share on other sites More sharing options...
Frank Lamb Posted September 13, 2004 Share Posted September 13, 2004 Kim, I think all the others pretty much have it above.Speaking for myself,I don't know if it is chemo brain,old age,or what but I have memory problems,all the time.Have had this for many years befor diag.(meet someone & can't remember their name 10 minutes later & things like that).I thought chemo brain was just a slang name for foggy,can't remember,headache etc,etc.Geuss I was wrong didn't know it was a real scenario. Quote Link to comment Share on other sites More sharing options...
mhutch1366 Posted September 13, 2004 Share Posted September 13, 2004 Chemo brain is real enough, funny thing, it just acts like old age, only worse. So my friends that haven't had cancer or chemo tell me about their aging brains.... Somedays I feel like I have holes in my brain you could drive a truck through..... Geesh..... If I can remember what I have to do each day and get myself and the children home and get us all fed and in bed ready for tomorrow I guess I've done okay. God bless us all . XOXOXOXOX MaryAnn Quote Link to comment Share on other sites More sharing options...
kimblanchard Posted September 16, 2004 Share Posted September 16, 2004 Good question about chemo and its effects on the brain. It is true that there is a barrier that prevents most chemotherapy drugs (most drugs period) from getting into the brain. The barrier is not complete so some of the drug does get in but not enough to kill off or prevent cancer. Even that is not totally true; the barrier breaks down once the cancer does spread into the brain and causes swelling. A good example is small cell lung cancer which most commonly goes to the brain. Many of my patients who have asymptomatic brain mets with small cell will have a very good response with chemo so I often don't automatically send them for radiation right away. The only drugs that cross the intact blood brain barrier well are topotecan, temozolomide and an older drug called BCNU. I am fairly certain that Taxotere does not cross the blood brain barrier very well if it is intact. There have been and are studies looking at PCI in patients with NSCLC that have shown that it definitely reduces the risk of cancer spreading to the brain. The trick is should it be done in every patient who has had curative treatment to prevent the cancer from showing up there later or only those who are at very high risk. The downside to PCI is that it can have pretty serious neurologic sequelae down the road and most people won't have needed it. If only we could accurately determine which people needed it and which didn't. I could really use a good crystal ball..... Joe Quote Link to comment Share on other sites More sharing options...
TAnn Posted September 16, 2004 Share Posted September 16, 2004 Joe, It is so great to hear from a doctor! Thank you for your input. I have learned so much from this board and we really appreciate it when we hear from the medical community. I am going for a brain MRI tomorrow as I have been having dull headaches for about 3 weeks now. I think it is hormones, but glad I am armed with all this information. Hoping for admittance to the "empty head" club! TAnn Quote Link to comment Share on other sites More sharing options...
john Posted September 16, 2004 Share Posted September 16, 2004 Dr Joe, What do you think of MMPIs? MMP-9 has been implicated in brain mets. A few studies showed no benefit; however, the patients already had brain mets. One Dr thought MMPIs could be used to prevent brain mets Thanks for your time and participating on the board John Quote Link to comment Share on other sites More sharing options...
kimblanchard Posted September 17, 2004 Share Posted September 17, 2004 Boy, you guys are taking the gloves off with your questions now! For those who don't know what we're talking about, MMPI stands for matrix metalloproteinase inhibitor, a new class of anticancer drug in clinical trials for lots of different cancers. Matrix metalloproteinases are a group of enzymes that are important for destroying stuff. For a cancer cell to metastasize, there are a number of nasty tricks that it has to learn. It has to forget how to be cohesive in the tissues where it is growing so that it can break off. It has to learn to grow in the new hostile "soil" in which it lands. There are two very important things that have to take place for cancer cells to do this. First they have to create a food supply (angiogenesis). Second they have to dig themselves in by destroying the tissues around them (proteolysis amongst other olyses). MMPs are the enzymes that allow the cells to invade the new tissues and make themselves at home. MMPIs are new drugs that turn this ability off. Overexpression of MMPs has been demonstrated in a number of cancers. MMP-9 is thought to be important in the growth of both primary brain tumors (glioblastoma multiforme) and in tumors metastatic to the brain. I am not aware of any MMPIs that have been shown to be effective in lung cancer although I hear rumors that Novartis has one in the pipeline that is really promising. I have taken part in 2 MMPI clinical trials and both were negative although neither were for lung cancer. The only trial I'm aware of that might reflect on your question was a randomized trial that looked at an adjuvant MMPI in patients with Stage 3/4 NSCLC and another in patients with SCLC. They were randomized to the MMPI or placebo. There actually was a recurrence free survival benefit in the NSCLC group but a worsening of recurrence free survival in the SCLC group. Overall survival was the same with drug or placebo in both groups. There was no difference in incidence of development of brain mets with drug or no drug (although study not specifically designed to answer that question). So are they helpful? Dunno. Either the smart guys who develop these drugs are wrong about their target (doubtful) or the first generation of drugs is just not quite good enough (probable). I bet one of these MMPIs is going to work though. Just too good of an idea not to. Joe Quote Link to comment Share on other sites More sharing options...
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