Rahul Jandial, M.D., Ph.D., assistant professor in the Division of Neurosurgery, received a $250,000 gift from an anonymous donor to support his ongoing research into breast cancers that metastasize to the brain.

Breast cancer is one of several cancers that can spread to the brain. (Image by Mikael Häggström)

As breast cancer treatment evolves, these metastatic tumors are becoming a growing challenge for patients and their doctors. Many new therapies can suppress breast cancer within most of the body, but not the brain.

“Cancers that metastasize, or spread from their original site, are the most common cause of malignant disease in the brain,” said Jandial. “Worryingly, brain metastases are increasingly a first site of relapse in certain types of breast cancer, often while systemic disease is well controlled.”

Jandial explained that physicians recommend different therapies for tumors that originate within the brain than for breast cancer that has spread to the brain. But treatment strategy is even more complicated than that.

A treatment that may be effective against breast cancers within the breast or lymph nodes may not work in the brain, for various reasons. The treatment may be too damaging to brain cells or the breast cancer drug may fail to get through blood vessel walls in the brain. Many drugs are blocked by the blood-brain barrier, which serves as a natural wall to keep most foreign cells and toxins from the sensitive organ.

Cancer spread to the brain is a far-reaching problem: About 200,000 cancer patients in the U.S. each year are diagnosed with metastatic brain tumors.

Historically, Jandial said, metastatic breast cancer patients usually struggled mostly with cancer that had progressed to places like the lungs or bones. Cancer tended to spread to the brain late in the illness, so a lack of good treatments for brain metastases had little impact.

Today, due to targeted cancer therapies, that is no longer the case. Brain specialists are now finding themselves dealing with more breast cancer cases.

“In some ways it remains unconventional to consider a neurosurgeon a breast cancer doctor and researcher,” Jandial said, “but indeed this has become the case as better systemic therapies continue to extend patient’s lives.

Rahul Jandial

“With the introduction of personalized medicines such as Herceptin, and many more on the way, women are living longer with breast cancer. Treatment with Herceptin has revealed a certain population of patients who have brain metastases even though their breast cancer is being controlled, and those patients are dying from this dreaded complication of cancer — metastasis.”

Herceptin fights cancers that have a mutation in the human epidermal growth factor receptor 2, or HER2, gene. Jandial cites one study that found that half of breast cancer patients with HER2 gene mutation still developed brain metastases even though they responded to chemotherapy or their cancer had stabilized and growth had slowed. Of those diagnosed with brain metastases, half died from their brain tumors.

Understanding the biology of cancer cells that settle and grow in the brain is crucial, and Jandial’s laboratory will contribute to this much-needed knowledge. One of his first goals: bringing knowledge from neuroscience and neurosurgery into the investigation. “This perspective could offer a new source to develop targeted therapies for women with advanced breast cancer,” he said.

The initial focus of his study is on breast metastases to the brain, but Jandial says the findings have the potential to apply to other cancers that spread to the brain as well.

“Brain tumor research has shown us that cancer, whether arising from the brain or spreading to the brain, is a uniquely frightening event that threatens both life and independence,” he added. “Our long-term goal is not only to add years to the lives of women with advanced breast cancer, but also to add quality of life to their years.”