Is brain the new bone marrow?

Abstract

At the recent Society for Neuro-Oncology meeting in Montreal, more than a few clinicians and scientists concluded (as they do every year) that little progress has been made in the treatment of malignant primary brain tumors. Skepticism persists among neuro-oncologists for good reason. Despite the discovery of novel therapeutic targets, innovative methods of drug delivery, and sophisticated imaging modalities, patient survival has scarcely changed in 30 years. Sadly, we have accumulated much information, but little useful knowledge. In addition to a lack of progress in treating primary brain tumors, the threat of nervous system toxicity as a consequence of chemotherapy and cranial irradiation looms ever larger, not just in patients with nervous system cancer, but in all patients with cancer. In fact, a good case can be made that the nervous system has supplanted the bone marrow as the dose-limiting end organ for much of modern-day cancer therapy. Clearly we need a new paradigm for developing drugs in the laboratory and selecting drugs in the clinic. In this issue of Neurology ®, Gong et al.1 address these …