THE CDMRP FUNDS RESEARCH TO ENHANCE TREATMENT AND UNDERSTANDING OF BRAIN METASTASES IN LUNG CANCER

Congress first appropriated funds to the Congressionally Directed Medical Research Programs for lung cancer research in FY09, establishing the Lung Cancer Research Program. In FY24, the LCRP received $25 million in appropriations and supports research to reduce the burden of lung cancer and improve the lives of Service Members and their Families, Veterans and the general public.

In the United States, lung cancer is the third most common cancer and is the leading cause of cancer mortality, accounting for 20% of all cancer-related deaths. According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, about 5.7 percent of people will receive a lung and/or bronchus cancer diagnosis in their lifetime. In 2021, about 610,000 people lived with lung cancer in the United States despite the 5-year relative survival rate being 26.7%.

The LCRP funds interdisciplinary research to improve risk assessment, prevention, early detection, diagnosis and treatment for the control and cure of lung cancer.

BRAIN METASTASIS – A CRITICAL GAP IN LUNG CANCER RESEARCH

Brain metastasis impacts 20%-40% of cancer patients. Lung cancer is known to metastasize, or spread, to the brain. Between 10% and 36% of all lung cancers will spread to the brain during the course of the disease.

Laura Greco, a LCRP programmatic panel member between FY19 and FY24, lived with lung cancer and brain metastasis for nine years before her death in 2024.

Over the course of her nearly decade-long experience with cancer, Greco’s treatment included thoracic surgery to remove part of her left lung and lymph nodes in her chest and countless rounds of targeted radiation to combat tumors in her body and in her brain. She also underwent nine invasive brain operations and received traditional chemotherapies and targeted genetic drugs.

The LCRP programmatic panel, including Greco, encouraged the program to fund research focused on brain metastases, a historically complicated aspect of cancer research.

“I was allowed to go 15 months after my initial treatments and my surgical lobectomy without magnetic resonance imaging of my brain under the assumption that my cancer would reappear in my chest before it appeared in my brain,” Greco said. “That assumption was wrong. I had 12 tumors that were all advanced in size and causing observable symptoms in my brain without any new cancer activity in my chest.”

The LCRP includes community members living with or impacted by a lung cancer diagnosis in the program’s strategic planning and two-tier review process. Alongside the scientific experts in the cancer research community, they ensure funded research addresses critical gaps in understanding lung cancer and patient care.

In FY23, as part of the LCRP’s annual strategic planning process, the program updated the research priorities to include a brain metastasis focus. This area of emphasis focuses on enhancing the understanding, detection and treatment of brain and leptomeningeal metastases in lung cancer. Leptomeningeal metastases occur when cancer spreads to cerebrospinal fluid and the membranes surrounding the brain and spinal cord.

Prior to FY23, the LCRP addressed lung cancer metastasis more broadly, identifying a need for innovative strategies to prevent recurrence or metastases, such as brain metastases.

LCRP-FUNDED RESEARCH ADDRESSING BRAIN METASTASIS

The microenvironment of the brain serves as a place where cancer cells can escape and seed future relapse, and the blood-brain barrier is difficult for medical treatments to penetrate.

Swarnali Acharyya, Ph.D., and her team at the Columbia University Medical Center, studies the biology of cancer metastasis hoping to better understand therapeutic-resistant metastatic tumors and the effects of metastases on the body. The LCRP first awarded Acharyya an Idea Development Award in FY22 to understand the underlying mechanisms of brain metastases and improve targeted therapy outcomes, filling a critical gap in the field.

With an FY23 Concept Award, Acharyya and her team are also investigating the role of synucleins, a small protein primarily found in neural tissue and some types of tumors, in brain metastasis. Abnormal accumulation of this protein is known to result in neurodegenerative diseases, like Parkinson’s and Alzheimer’s. If the hypothesis correctly predicts that synucleins have a role in brain metastases, then current treatments being tested to target synucleins in neurodegenerative diseases could be repurposed to treat brain metastases.

In FY23, the LCRP awarded an Idea Development Award to Luke Pike, M.D., Ph.D. at Memorial Sloan Kettering Cancer Center. Pike and his team are working to understand the biology that helps cancer cells spread and survive in the brain.

If successful, clinicians could detect brain metastasis before tumors cause harm or provide patients with known treatments to positively impact the brain.

Understanding the biology of brain metastasis could also allow researchers to investigate novel therapeutics to prevent lung cancer from spreading to the brain or improve treatment for existing brain metastases.

LCRP-FUNDED RESEARCH IMPACTS PATIENTS’ LIVES

According to Greco, she remained active in lung cancer outreach and research because she wanted to be part of the solution.

“I am so grateful that the LCRP gives me an opportunity, in an important way, to help influence the direction of lung cancer research,” Greco said while serving as a programmatic panel member.

The LCRP remains dedicated to funding scientific research to transform how we identify, treat, and manage lung cancer, including brain metastases. The program is also committed to including community members who enrich the scientific review process.

“Patients with brain metastases deserve better,” Greco said.