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Transmissible spongiform encephalopathy

“Historically, women with brain mets have been excluded from clinical trials due to overall poor prognosis,” says Cittelly, pointing out that earning approval for a new drug requires showing its effectiveness, and even a promising drug may seem ineffective in patients whose cancer has already metastasized to the brain. “So we have never explored whether anti-estrogens will have benefit for these women. Our work shows there might be a benefit in anti-estrogen therapies in preventing brain metastasis in women with triple-negative breast cancer.”

Additionally, Cittelly and colleagues recently received funding to explore interceding elsewhere in this chain of action that starts with estrogen and ends with brain metastasis. Basically, if estrogen works through EGFR or TRKB, it may be useful to inhibit EGFR and/or TRKB, alone or together, in these patients. Fortunately, like estrogen-receptor inhibitors, EGFR and TRK inhibitors already exist and are in use with other cancers, making testing these strategies dramatically more feasible.

“We are finally beginning to recognize the unique role of the microenvironment in the brain,” Cittelly says. “Cancer metastasis may not depend on cancer cells alone. Stopping metastasis in these patients may require looking at the conditions of tissues that surround and support cancers.”