{"entity":{"id":"idea-fund-brain-metastases-programme","kind":"idea","name":"Treat brain metastases as a disease with its own trials programme","aka":[],"tldr":"A fifth of patients with solid tumours develop brain metastases and are usually excluded from trials. This would fund a programme that studies and treats them as a disease in their own right.","summary":"A funded network of brain-metastasis centres runs dedicated trials (systemic agents with CNS activity, radiosurgery sequencing, prevention in high-risk groups such as HER2-positive breast and EGFR/ALK lung cancer), builds a shared registry and tissue bank of resected metastases, and develops CNS-specific endpoints accepted by regulators. Funders and regulators would jointly discourage the routine exclusion of patients with stable brain metastases from registration trials.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Funding follows fashion, not burden): Carter & Nguyen, A comparison of cancer burden and research spending (BMC Cancer 2012)","url":"https://doi.org/10.1186/1471-2407-12-526"}],"tags":[],"related":["idea-fund-metastasis-moonshot"],"cancers":["nsclc","breast-her2-positive","melanoma","glioblastoma"],"sections":[],"technologies":["sbrt","whole-body-mri"],"targets":[],"drugs":["tucatinib","osimertinib"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-funding-allocation","b-brain-delivery"],"keyPapers":["paper-sun-bmc-cancer","paper-flaura-nejm-2018","paper-osimertinib-nsclc-n-engl-j-med-2017","paper-osimertinib-nsclc-n-engl-j-med-2020"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A dedicated programme raises the share of registration trials in lung, breast and melanoma that include patients with brain metastases from a minority to a majority within six years and produces at least two CNS-specific labels or guideline changes.","rationale":"Where brain metastases have been studied deliberately (tucatinib in HER2CLIMB, osimertinib CNS analyses, radiosurgery versus whole-brain trials) practice changed quickly; the constraint is that nobody funds the field systematically because it cuts across tumour-type programmes.","test":"Fund a five-centre pilot with a registry and two trials, and audit whether registration trials launched in the pilot's tumour types during the period relax their CNS exclusion criteria compared with the prior five years.","maturity":"speculative","actor":"research","cost":"large","horizonYears":6},"route":"/ideas/idea-fund-brain-metastases-programme/","neighbours":{"idea":[{"id":"idea-fund-metastasis-moonshot","kind":"idea","name":"A ring-fenced metastasis programme with metastasis-specific endpoints","route":"/ideas/idea-fund-metastasis-moonshot/"},{"id":"idea-lung-brain-metastasis-prevention-as-a-primary-endpoint","kind":"idea","name":"Measure brain metastasis prevention as a primary endpoint, not as a secondary one","route":"/ideas/idea-lung-brain-metastasis-prevention-as-a-primary-endpoint/"}],"cancer":[{"id":"glioblastoma","kind":"cancer","name":"Glioma & glioblastoma","route":"/cancers/glioblastoma/"},{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"technology":[{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"},{"id":"whole-body-mri","kind":"technology","name":"Whole-body MRI","route":"/technologies/whole-body-mri/"}],"drug":[{"id":"osimertinib","kind":"drug","name":"Osimertinib","route":"/drugs/osimertinib/"},{"id":"tucatinib","kind":"drug","name":"Tucatinib","route":"/drugs/tucatinib/"}],"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"b-brain-delivery","kind":"bottleneck","name":"The brain: barrier and sanctuary","route":"/bottlenecks/b-brain-delivery/"}],"paper":[{"id":"paper-sun-bmc-cancer","kind":"paper","name":"Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials","route":"/key-papers/paper-sun-bmc-cancer/"},{"id":"paper-flaura-nejm-2018","kind":"paper","name":"FLAURA: osimertinib as first treatment for EGFR-mutated lung cancer","route":"/key-papers/paper-flaura-nejm-2018/"},{"id":"paper-osimertinib-nsclc-n-engl-j-med-2017","kind":"paper","name":"Osimertinib or Platinum-Pemetrexed in EGFR T790M-Positive Lung Cancer","route":"/key-papers/paper-osimertinib-nsclc-n-engl-j-med-2017/"},{"id":"paper-osimertinib-nsclc-n-engl-j-med-2020","kind":"paper","name":"Overall Survival with Osimertinib in Untreated, EGFR -Mutated Advanced NSCLC","route":"/key-papers/paper-osimertinib-nsclc-n-engl-j-med-2020/"}]}}