ideasIdea
Require every oncology candidate to publish how much reaches the brain
Whether a drug gets into the brain is measured early in development but rarely published. Making that number public would show which existing drugs could treat brain disease.
Unbound brain-to-plasma partition coefficients are routinely generated in preclinical development and almost never disclosed, so clinicians and academic groups cannot tell which approved drugs are worth testing in central nervous system disease. A disclosure requirement at investigational new drug or marketing authorisation stage, or a voluntary public registry, would create a searchable resource at near-zero cost.
Hypothesis
A public brain exposure registry identifies at least 20 approved oncology drugs with meaningful brain penetration that are not currently used for central nervous system disease, at least five of which merit trials.
Rationale
Similar mandated disclosures, such as trial registration and results reporting, changed behaviour quickly once required. The data already exist inside companies, so the marginal cost of publication is trivial relative to the value of knowing.
What would test it
Ask ten companies to disclose historical brain exposure data for approved oncology drugs voluntarily; publish the registry and measure how many new central nervous system trials cite it within two years.
Maturity
speculative
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks
- The brain: barrier and sanctuary · Most drugs cannot cross into the brain, so brain tumours and brain metastases lag every other site.
- Failures are hidden · Negative trials, failed drugs and abandoned programmes are rarely published, so the same mistakes are repeated.
- Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.