Brain metastases arising from solid tumors (e.g. lung, breast, melanoma and renal cancers) are a devastating consequence of late-stage cancer and are associated with poor prognoses and limited treatment options. In the past decade, the incidence of brain metastasis has significantly increased as many patients are surviving longer due to effective cancer therapies that do not prevent or treat brain metastases. In contrast to non-brain metastasis settings, there has been only modest improvement over the past 20 years in the survival of patients with brain metastasis.
On a more promising note, the advent of next-generation sequencing, RNA transcriptional analysis and immune profiling has begun to shed new light on the complex biology of brain metastasis. These advances lay the foundation for a dedicated effort to evaluate the efficacy of targeted agents and other novel therapeutic approaches to address brain metastasis.
Duke's teams will deliver multidisciplinary cancer care to patients with different tumor types that have metastasized to the brain and apply novel imaging, surgical and radiation techniques, along with research-driven therapeutic development, with the goal of making transformative changes in their survival and quality of life.
In addition to streamlining the multidisciplinary care of this complex patient population, this initiative will include the following three strategic research priorities:
- Investigating immune modulation and its effects on the development, propagation and treatment of brain metastasis.
- Improving and monitoring drug and other therapeutic delivery throughout the intracranial compartment.
- Accelerating novel therapy development through templated and streamlined clinical trials across tumor types.
Problem:
- Brain metastases from solid tumors pose unique and difficult challenges:
- Devastating symptoms for patients:
- Headaches, Seizures, Vomiting, Weakness, Loss of Vision, Cognitive Decline, Personality Changes
- Poor penetration of therapies
- Exclusion from clinical trials
- Devastating symptoms for patients:
- Brain metastases are rising in incidence.
- As treatment for systemic disease has improved and patients survive longer, they live to develop brain metastases.
- Twenty to forty percent of all cancer patients will now develop brain metastases*.
- Brain metastases are especially prevalent in patients with lung, breast, melanoma, and renal cell carcinoma cancer.
- Survival for patients with brain metasteses remains less than 5% at 2 years.
- Few therapies, trials, or programs exist specifically for patients with brain metastases.
Solution:
- Develop novel approaches to prevention, early diagnosis, and treatment gained through patience-centric, multidisciplinary research and care for patients
- Develop a renowned, patient-centric, multi-disciplinary, stream-lined research, care, and clinical trials center for patients with brain metastases, taking advantage of many existing Duke strengths:
- Neurosurgery
- Radiation Oncology
- Medical Oncology
- Imaging / Radiology
- Brain Tumor Immunotherapy Program
- Extensive Clinical Trials Infrastructure
- Preston Robert Tisch Brain Tumor Center
- Pratt School of Engineering
Impact:
- Prevention
- Therapeutic development
- Improved imaging and diagnosis
- Clinical Trials
- Improved quality of life improvement for survivors