Triple Neg Chemos for BRAIN METS

Megan,

I don't believe there is such thing as triple negative chemo, either for brain or other organs.

For brain especially, triple negatives have been treated the same way as other brain mets.  With the exception of Tykerb that is only likely to work for HER2, as far as I know the only standard "chemo" accepted to treat brain mets from bc is Xeloda.  Temodar is not widely accepted yet, although it's in a lot of trials for brain mets from bc and a lot of oncologists start using it.  I don't know much about Patupilone, but I sure do hope they're going to add it to the arsenal soon.

Methotrexate does not cross blood brain barrier, so the only way to get it is to inject it directly into the cerebrospinal fluid, either through ommaya port (chemo port implanted in the head) or lumbar puncture.  DepoCyt is another chemo you get through ommaya port.

Because using ommaya port is a big deal, and people want to avoid that, I think a lot of researchers now want to look for chemos that cross the blood brain barrier (thus eliminating the need for ommaya port or lumbar puncture).  Like Lisa, I heard about Doxil being promising too.  I don't know what it would take for them to say "yea, Doxil does cross BBB!"  In my mind it seems simple, it either does or doesn't.  But I guess that's not the case.

Hope all is well with you.

Hi Megan,

Besides what the others have told you, this is what I have in my folder of Last Options:

Gemzar

Irinotecan/Temodar trial

Lomustine (also called: CeeNu and CCNU)

Sutent/Xeloda trial

RexinG (if you could get it off label.  It does have orphan drug status w/FDA)

And here are a few

Molecular Wgts: Lomustine 233.69Temodar 194.15Xeloda 359.35Tamoxifen 371.5 (I left this since it HAS shown some effects w/brain and er+...just for the size of it to compare...fyi)

I'm the one whose done so "well" with Xeloda/Temodar....

oxoxpattyz

Well!  On Molecular wgts.....

When a drug is reported to be used to some effect for brain mets, I look it up, size wise.  I like to see just what the size actually IS. 

 I saved the following info in regard to that because it was so well researched and was in line with all the different reports I had read.  Now, this was early in Jan. '05, so the 'news' on Xeloda is WAY better than he had known at the time.  At least for ME!

1) For a drug to cross an "in-tact" blood brain
barrier, several criteria must be met. One such
criteria is that the drug must have a very, very small
molecular weight - some say below 400 daltons...

not a firm number but you get the
idea. (over 98% of all drugs do not cross the
barrier--even if they are called "small molecule")

2) many drugs of somewhat larger size can cross a
"leaky" blood brain barrier. The BBB often gets leaky
from the presence of brain tumors or radiation, so more drugs may
actually have an effect on brain mets despite that
such drugs would not cross an in-tact BBB.

3) very large drugs will probably not work whether the
BBB is in-tact or leaky. IE Herceptin is 140,000
daltons, which is too large. This is why Dr Winer at
Dana Farber is conducting a trial with GW572016 (943
daltons) on brain mets for with who are HER2 +.
Iressa is a similar class of drug as GW572016 (now named Tykerb)

 and has
shown activity against brain mets from non small cell
lung cancer.

4) There are drugs that are known to cross the
barrier, and this fact has been measured. For
example, Temodar (approximately 189 daltons) crosses
the BBB. Thalidomide crosses the barrier, but this is
not a chemo, rather it is being investigated for
anti-angiogenic properties in brain mets.

5) Xeloda (389 daltons) is BELIEVED to cross the BBB,
in some cases very strongly believed - and there are
anectodal accounts of remission of brain mets from use
of Xeloda, but this proposition has never been
measured and proven. My sister just finished using
Xeloda for her multiple brain mets (she already had
WBR and several SRS treatmetns). The Xeloda did appear
to have a positive effect, as some lesions shrank
after the first cycle...but after the 3rd cycle, some
shrank and some grew slightly...thus Judi is going on
the GW572016 trial.

5) Even if a drug crosses the BBB, it must (i) achieve
good disbursement within the brain and within the
targeted lesions.

Well I started on Doxil last wk w/ the hope that it will cross the BBB... so we'll see if that's the case.

I'm sort of back... my butt is still dragging from the evil decadron & it's making me feel like such a wimp!  Sat was my last dose, so hopefully things start to improve.  Now my face is horrible, too... it's odd to me that so many of the SE's took a while to hit me.  Anyway, hopefully now that I'm off the nasty stuff maybe things will start to improve... I have never felt so frustrated since dx!!!!

hhfp, my MO recommended an Immunotherapy trial since your immune system has no problem with the BBB. We haven’t quite figured out Immunotherapy yet so the percentage of patients it works for is low, but if it does work the benefits are great. Especially for brain mets as it usually has a durable response from the information I’ve gathered. Not sure about chemotherapy specific for brain mets only that if there is irritation or inflammation in the brain/BBB it is easier for the chemo to pass through.