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Depner JF, Berg T, Ejlertsen B, Andreasen LW, Møller S, Maraldo MV. Treating brain metastases in metastatic breast cancer: outcomes after stereotactic radiosurgery examined in a retrospective, single-center cohort analysis. Acta Oncol 2023; 62:1502-1510. [PMID: 37750329 DOI: 10.1080/0284186x.2023.2260942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION We examined the role of receptor profiles and other prognostic factors in survival outcomes after stereotactic radiosurgery (SRS) for brain metastases in breast cancer patients, to help improve selection of candidates for SRS. MATERIAL AND METHODS We included 149 consecutive patients who received SRS between 2012 and 2019 at the University Hospital of Copenhagen, Rigshospitalet, Denmark. Overall survival (OS) following SRS was determined through the Kaplan-Meier method, while CNS progression-free survival (CNS-PFS) was determined through competing risk analysis. Prognostic factors for both OS and CNS-PFS were evaluated through uni- and multivariate Cox regression and Fine-Gray models, respectively. The proportional hazards assumptions were tested through Schoenfeld residuals, and non-proportionality was accounted for by the inclusion of time-dependent variables. RESULTS Median OS was 14.8 months for the entire cohort and was as follows for the four receptor profiles: 33.3 months for ER+/HER2+ (ER: estrogen receptor, HER2: human epidermal growth factor receptor 2), 11.0 months for ER+/HER2-, 17.7 months for ER-/HER2+, and 5.3 months for ER-/HER2-. In the multivariate model, the ER-/HER2- receptor profile (hazard ratio (HR): 2.00, 95% confidence interval (CI): 1.09-3.67) and the presence of extracranial visceral metastases (HR: 2.90, 95% CI: 1.53-5.50) were associated with worse OS. The ER+/HER2+ receptor profile (HR: 0.43, 95% CI: 0.19-0.96) and 5+ lines of treatment (HR: 0.40, 95% CI: 0.20-0.82) were both associated with improved OS. For CNS-PFS, 5+ lines of treatment (sub-distributional hazard ratio (SHR): 2.88, 95% CI: 1.06-7.81) was associated with worse CNS-PFS, while extracranial visceral metastases (SHR: 0.54, 95% CI: 0.30-0.97) was associated with reduced risk of CNS progression - which is primarily due to patients with extracranial metastases dying before developing new CNS progression. CONCLUSION Extracranial visceral disease and the ER-/HER2- receptor profile were associated with poor survival outcomes following SRS.
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Affiliation(s)
- Julie F Depner
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tobias Berg
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lærke W Andreasen
- Department of Clinical Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren Møller
- Department of Clinical Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maja V Maraldo
- Department of Clinical Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Khatri VM, Mills MN, Oliver DE, Yu HHM, Vogelbaum MA, Forsyth PA, Soliman HH, Han HS, Ahmed KA. Tucatinib and stereotactic radiosurgery in the management of HER2 positive breast cancer brain metastases. J Neurooncol 2023; 164:191-197. [PMID: 37490232 DOI: 10.1007/s11060-023-04402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE HER2-positive breast cancer has a high risk of brain metastasis. Stereotactic radiosurgery (SRS) is standard of care for limited brain metastases. Tucatinib, a HER2-targeted tyrosine kinase inhibitor, has demonstrated intracranial efficacy in the HER2-CLIMB Trial. However, it is unknown whether tucatinib with SRS is safe or effective. METHODS A retrospective analysis of HER2-positive breast cancer treated with SRS and tucatinib for brain metastases management was performed. All patients received tucatinib and SRS for the management of active brain metastases. The primary endpoint was local and distant brain tumor control. Secondary endpoints were intracranial progression free survival (CNS-PFS), systemic PFS, overall survival (OS), and neurotoxicity. RESULTS A total of 135 lesions treated with SRS over 39 treatment sessions in 22 patients were identified. Median follow-up from tucatinib initiation was 20.8 months. Local brain control was 94% at 12-months and 81% at 24-months. Distant brain control was 39% at 12-months and 26% at 24-months. Median survival was 21.2 months, with 12- and 24-month OS rates of 84% and 50%, respectively. Median CNS-PFS was 11.3 months, with 12- and 24-month CNS-PFS rates of 44.9% at both time points. Median systemic PFS was not reached, with 12- and 24-month systemic PFS rates of 86% and 57%, respectively. Symptomatic radiation necrosis occurred in 6 (4%) lesions. No additional unexpected toxicities were noted. CONCLUSIONS SRS in combination with tucatinib, capecitabine, and trastuzumab appears to be a safe and feasible treatment for HER2 + brain metastases. Further prospective evaluation of potential synergistic effects is warranted.
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Affiliation(s)
- Vaseem M Khatri
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Hatem H Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Hyo S Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
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de Castro DG, Pellizzon ACA, Braun AC, Chen MJ, Silva MLG, Fogaroli RC, Gondim GRM, Ramos H, Neto ES, Abrahão CH, Yu LS, Abdallah EA, Calsavara VF, Chinen LTD. Heterogeneity of HER2 Expression in Circulating Tumor Cells of Patients with Breast Cancer Brain Metastases and Impact on Brain Disease Control. Cancers (Basel) 2022; 14:cancers14133101. [PMID: 35804873 PMCID: PMC9264951 DOI: 10.3390/cancers14133101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Results from a previous study suggested that the number of circulating tumor cells (CTC) might have a role as a biomarker of early distant brain failure in patients with breast cancer brain metastases (BCBM). However, it remains largely underexplored whether heterogeneous HER2 expression in CTC may have a prognostic implication. We evaluated the status of HER2 expression in CTC before and after radiotherapy/radiosurgery for BCBM and observed that the presence of HER2 expression in any moment was associated with longer distant brain failure-free survival, irrespective of the primary immunophenotype of the breast tumor. This finding suggests that the status of HER2 expression in CTC has the potential to improve the treatment selection for patients with BCBM. Abstract HER2 expression switching in circulating tumor cells (CTC) in breast cancer is dynamic and may have prognostic and predictive clinical implications. In this study, we evaluated the association between the expression of HER2 in the CTC of patients with breast cancer brain metastases (BCBM) and brain disease control. An exploratory analysis of a prospective assessment of CTC before (CTC1) and after (CTC2) stereotactic radiotherapy/radiosurgery (SRT) for BCBM in 39 women was performed. Distant brain failure-free survival (DBFFS), the primary endpoint, and overall survival (OS) were estimated. After a median follow-up of 16.6 months, there were 15 patients with distant brain failure and 16 deaths. The median DBFFS and OS were 15.3 and 19.5 months, respectively. The median DBFFS was 10 months in patients without HER2 expressed in CTC and was not reached in patients with HER2 in CTC (p = 0.012). The median OS was 17 months in patients without HER2 in CTC and was not reached in patients with HER2 in CTC (p = 0.104). On the multivariate analysis, DBFFS was superior in patients who were primary immunophenotype (PIP) HER2-positive (HR 0.128, 95% CI 0.025–0.534; p = 0.013). The expression of HER2 in CTC was associated with a longer DBFFS, and the switching of HER2 expression between the PIP and CTC may have an impact on prognosis and treatment selection for BCBM.
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Affiliation(s)
- Douglas Guedes de Castro
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
- Correspondence:
| | - Antônio Cássio Assis Pellizzon
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Alexcia Camila Braun
- International Research Center, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.B.); (E.A.A.)
| | - Michael Jenwei Chen
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Maria Letícia Gobo Silva
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Ricardo Cesar Fogaroli
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Guilherme Rocha Melo Gondim
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Henderson Ramos
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Elson Santos Neto
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Carolina Humeres Abrahão
- Department of Radiation Oncology, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.A.P.); (M.J.C.); (M.L.G.S.); (R.C.F.); (G.R.M.G.); (H.R.); (E.S.N.); (C.H.A.)
| | - Liao Shin Yu
- Department of Imaging, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil;
| | - Emne Ali Abdallah
- International Research Center, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil; (A.C.B.); (E.A.A.)
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Luo X, Zhang Q, Chen H, Hou K, Zeng N, Wu Y. Smart Nanoparticles for Breast Cancer Treatment Based on the Tumor Microenvironment. Front Oncol 2022; 12:907684. [PMID: 35720010 PMCID: PMC9204624 DOI: 10.3389/fonc.2022.907684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/28/2022] [Indexed: 01/30/2023] Open
Abstract
Breast cancer (BC) is the most common malignant tumor in women. There are different risk characteristics and treatment strategies for different subtypes of BC. The tumor microenvironment (TME) is of great significance for understanding the occurrence, development, and metastasis of tumors. The TME plays an important role in all stages of BC metastasis, immune monitoring, immune response avoidance, and drug resistance, and also plays an important role in the diagnosis, prevention, and prognosis of BC. Smart nanosystems have broad development prospect in the regulation of the BC drug delivery based on the response of the TME. In particular, TME-responsive nanoparticles cleverly utilize the abnormal features of BC tissues and cells to achieve targeted transport, stable release, and improved efficacy. We here present a review of the mechanisms underlying the response of the TME to BC to provide potential nanostrategies for future BC treatment.
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Affiliation(s)
- Xiao Luo
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Zhang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbo Chen
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Hou
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Zeng
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiping Wu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Rubino S, Oliver DE, Tran ND, Vogelbaum MA, Forsyth PA, Yu HHM, Ahmed K, Etame AB. Improving Brain Metastases Outcomes Through Therapeutic Synergy Between Stereotactic Radiosurgery and Targeted Cancer Therapies. Front Oncol 2022; 12:854402. [PMID: 35311078 PMCID: PMC8924127 DOI: 10.3389/fonc.2022.854402] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Brain metastases are the most common form of brain cancer. Increasing knowledge of primary tumor biology, actionable molecular targets and continued improvements in systemic and radiotherapy regimens have helped improve survival but necessitate multidisciplinary collaboration between neurosurgical, medical and radiation oncologists. In this review, we will discuss the advances of targeted therapies to date and discuss findings of studies investigating the synergy between these therapies and stereotactic radiosurgery for non-small cell lung cancer, breast cancer, melanoma, and renal cell carcinoma brain metastases.
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Affiliation(s)
- Sebastian Rubino
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Daniel E Oliver
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Nam D Tran
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | | | - Kamran Ahmed
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Arnold B Etame
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
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Evolving management of HER2+ breast cancer brain metastases and leptomeningeal disease. J Neurooncol 2022; 157:249-269. [PMID: 35244835 DOI: 10.1007/s11060-022-03977-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/23/2022] [Indexed: 12/14/2022]
Abstract
Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a particularly high risk of breast cancer brain metastasis (BCBM) and leptomeningeal disease (LMD). Improvements in systemic therapy have translated to improved survival for patients with HER2-positive BCBM and LMD. However, the optimal management of these cases is rapidly evolving and requires a multidisciplinary approach. Herein, a team of radiation oncologists, medical oncologists, neuro-oncologists, and breast surgeon created a review of the evolving management of HER2-positive BCBM and LMD. We assess the epidemiology, diagnosis, and evolving treatment options for patients with HER2-positive BCBM and LMD, as well as the ongoing prospective clinical trials enrolling these patients. The management of HER2-positive BCBM and LMD represents an increasingly common challenge that involves the coordination of local and systemic therapy. Advances in systemic therapy have resulted in an improved prognosis, and promising targeted therapies currently under prospective investigation have the potential to further benefit these patients.
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Ippolito E, Silipigni S, Matteucci P, Greco C, Pantano F, D’Auria G, Quattrocchi CC, Floreno B, Fiore M, Gamucci T, Tonini G, Ramella S. Stereotactic Radiation and Dual Human Epidermal Growth Factor Receptor 2 Blockade with Trastuzumab and Pertuzumab in the Treatment of Breast Cancer Brain Metastases: A Single Institution Series. Cancers (Basel) 2022; 14:cancers14020303. [PMID: 35053467 PMCID: PMC8774076 DOI: 10.3390/cancers14020303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 01/19/2023] Open
Abstract
(1) Background: This study aims to assess the safety and efficacy of fractionated SRT (fSRT) and pertuzumab-trastuzumab (PT) in patients with breast cancer brain metastases (BCBM). (2) Methods: Patients with HER2+ BCBM who received FSRT from 2015 to 2019 were identified. Patients were included if they were treated with fSRT within 21 days of receiving PT. All lesions were treated with LINAC-based fSRT to a total dose of 27 Gy delivered in three consecutive fractions. All patients received concurrent PT. Patients were evaluated 4-6 weeks after SRS and subsequently every 2-3 months with MRI re-imaging (3) Results: A total of 49 patients with HER2+ brain metastases were identified. Of these patients, a total of 10 patients with 32 HER2+ BCBM were treated with concurrent SRT and PT and included in the analysis. No local progression was observed. Overall response rate was 68.7%. Only one patient developed asymptomatic radionecrosis. Median time to BM occurrence was 15.6 (range: 1-40.5 months). Distant intracranial failure occurred in 4/10 patients (40.0%). Overall BCBM median survival was 33.9 months (95%CI 24.1-43.6). Mean duration of PT treatment was 27.9 months (range: 10.1-53.7 months). (4) Conclusions: In our single institution experience, fSRT and PT showed to be a safe treatment for patients with BCBM with an adequate overall response rate.
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Affiliation(s)
- Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
- Correspondence: ; Tel.: +39-06-22541-1708
| | - Sonia Silipigni
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Paolo Matteucci
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (F.P.); (G.T.)
| | - Giuliana D’Auria
- Department of Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy; (G.D.); (T.G.)
| | - Carlo Cosimo Quattrocchi
- Department of Diagnostic Imaging and Interventional Radiology, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Barnaba Floreno
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Michele Fiore
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
| | - Teresa Gamucci
- Department of Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy; (G.D.); (T.G.)
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (F.P.); (G.T.)
| | - Sara Ramella
- Department of Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy; (S.S.); (P.M.); (C.G.); (B.F.); (M.F.); (S.R.)
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