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Chew SM, Ferraro E, Safonov A, Chen Y, Kelly D, Razavi P, Robson M, Seidman AD. Impact of cyclin dependent kinase 4/6 inhibitors on breast cancer brain metastasis outcomes. Eur J Cancer 2024; 207:114175. [PMID: 38896996 DOI: 10.1016/j.ejca.2024.114175] [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: 02/08/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Cyclin dependent kinase 4/6 inhibitors (CDK4/6i) are recommended 1st line treatments in HR+HER2- metastatic breast cancer. However, the impact of prior CDK4/6i on the natural history of brain metastases (BM) is not well described. MATERIALS AND METHODS We reviewed retrospective data for 363 patients with HR+HER2- BM who received a CDK4/6i (CDK-Y) between 1 Jan 2015 to 31 July 2021 and 299 patients with HR+HER2- BM who did not receive a CDK4/6i (CDK-N) between 1 Jan 2010 to 31 Dec 2014. CNS PFS and OS were assessed in patients who received CDK4/6i after BM. OS from the time of BM development was assessed between patients who received CDK4/6i before BM and the CDK-N cohort RESULTS: In the CDK-Y cohort of 363 patients, 203 (56 %) received a CDK4/6i before BM, 133 (37 %) received a CDK4/6i only after BM and 27 (7 %) received a CDK4/6i both before and after BM. Median CNS PFS was 21.4 months for patients receiving a CDK4/6i only after BM and 9.4 months for patients who received CDK4/6i both before and after BM (p = 0.006). Median OS was 24.9 months for patients receiving a CDK4/6i only after BM and 12.1 months for patients who received CDK4/6i both before and after BM (p = 0.0098). Median OS from time of BM development for patients receiving a CDK4/6i before BM versus the CDK-N cohort was 4.3 months and 7.7 months respectively (p = 0.0082). CONCLUSIONS CDK4/6i exposure prior to BM may lead to development of resistance mechanisms which in turn reduces CNS PFS and OS upon rechallenging with a CDK4/6i after BM development. This motivates investigation of biomarkers for patient selection.
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Affiliation(s)
- Sonya M Chew
- Medical Oncology Service, University Hospital Galway, Galway, Ireland
| | - Emanuela Ferraro
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Anton Safonov
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Yuan Chen
- Epidemiology-Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Daniel Kelly
- Technology Division, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Pedram Razavi
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Mark Robson
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Andrew D Seidman
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, USA.
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Freedman RA, Heiling HM, Li T, Trapani D, Tayob N, Smith KL, Davis R, Pereslete AM, DeMeo MK, Cotter C, Chen WY, Parsons HA, Santa-Maria CA, Van Poznak C, Moy B, Brufsky AM, Melisko ME, O'Sullivan CC, Ashai N, Rauf Y, Nangia JR, Burns RT, Savoie J, Wolff AC, Winer EP, Rimawi MF, Krop IE, Lin NU. Neratinib and Ado-Trastuzumab-Emtansine for Pre-treated and Untreated HER2-positive Breast Cancer Brain Metastases: Translational Breast Cancer Research Consortium Trial 022. Ann Oncol 2024:S0923-7534(24)01015-9. [PMID: 38977064 DOI: 10.1016/j.annonc.2024.07.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE Treatment options for HER2-positive breast cancer brain metastases (BCBM) remain limited. We previously reported central nervous system (CNS) activity for neratinib and neratinib-capecitabine. Preclinical data suggest that neratinib may overcome resistance to ado-trastuzumab-emtansine (T-DM1) when given in combination. In TBCRC 022's cohort 4, we examined the efficacy of neratinib plus T-DM1 in patients with HER2-positive BCBM. PATIENTS AND METHODS In this multicenter, phase II study, patients with measurable HER2-positive BCBM received neratinib 160 mg daily plus T-DM1 3.6 mg/kg intravenously every 21 days in three parallel-enrolling cohorts (cohort 4A-previously untreated BCBM, cohorts 4B and 4C- BCBM progressing after local CNS-directed therapy without [4B] and with [4C] prior exposure to T-DM1). Cycle 1 diarrheal prophylaxis was required. The primary endpoint was the Response Assessment in Neuro-Oncology-Brain Metastases (RANO-BM) by cohort. Overall survival (OS) and toxicity were also assessed. RESULTS Between 2018-2021, 6, 17, and 21 patients enrolled to cohorts 4A, 4B, and 4C. Enrollment was stopped prematurely for slow accrual. The CNS objective response rate in cohorts 4A, 4B, and 4C was 33.3% (95% confidence interval [CI]: 4.3-77.7%), 35.3% (95% CI: 14.2-61.7%), and 28.6% (95% CI: 11.3-52.2%), respectively; 38.1-50% experienced stable disease for ≥6 months or response. Diarrhea was the most common grade 3 toxicity (22.7%). Median OS was 30.2 months (cohort 4A; 95% CI: 21.9, not reached [NR]), 23.3 months (cohort 4B; 95% CI: 17.6, NR), and 20.9 months (cohort 4C; 95% CI: 14.9, NR). CONCLUSION We observed Intracranial activity for neratinib plus T-DM1, including those with prior T-DM1 exposure, suggesting synergistic effects with neratinib. Our data provide additional evidence for neratinib-based combinations in patients with HER2-positive BCBM, even those who are heavily pre-treated.
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Affiliation(s)
- R A Freedman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - H M Heiling
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - T Li
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - D Trapani
- Division of New Drug Development for innovative therapies, European Institute of Oncology IRCCS, Milan, Italy; University of Milan, department of oncology and hematology, Milan, Italy
| | - N Tayob
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - K L Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - R Davis
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - A M Pereslete
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M K DeMeo
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - C Cotter
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - W Y Chen
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - H A Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - C A Santa-Maria
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - B Moy
- Massachusetts General Hospital, Boston, MA, USA
| | - A M Brufsky
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M E Melisko
- University of California at San Francisco, San Francisco, CA, USA
| | | | - N Ashai
- MedStar/Georgetown University, Washington, DC, USA
| | - Y Rauf
- University of North Carolina, Chapel Hill, NC, USA
| | - J R Nangia
- Baylor College of Medicine, Houston, TX, USA
| | - R T Burns
- The Emmes Corporation, Rockville, MD, USA
| | - J Savoie
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA; The Emmes Corporation, Rockville, MD, USA
| | - A C Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - E P Winer
- Yale Cancer Center, New Haven, CT, USA
| | - M F Rimawi
- Baylor College of Medicine, Houston, TX, USA
| | - I E Krop
- Yale Cancer Center, New Haven, CT, USA
| | - N U Lin
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA
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Avila J, Leone J, Vallejo CT, Lin NU, Leone JP. Survival analysis of patients with brain metastases at initial breast cancer diagnosis over the last decade. Breast Cancer Res Treat 2024; 205:579-587. [PMID: 38453783 DOI: 10.1007/s10549-024-07290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE There have been significant advances in the treatment of metastatic breast cancer (BC) over the past years, and long-term outcomes after a diagnosis of brain metastases are lacking. We aimed to identify predictors of brain metastases at initial breast cancer diagnosis, describe overall survival (OS) in the past decade, and identify factors associated with OS after brain metastases diagnosis. METHODS We evaluated patients with de novo stage IV BC using the Surveillance, Epidemiology and End Results database from 2010 to 2019. Multivariate logistic regression was conducted to assess predictors of brain metastases at initial breast cancer diagnosis. OS was estimated using the Kaplan-Meier method and log rank test was used to compare differences between groups. Cox regression was used to assess associations between several variables and OS. RESULTS 1,939 patients with brain metastases at initial breast cancer diagnosis were included. Factors associated with this presentation were grade III/IV tumors, ductal histology, hormone receptor (HR)-negative/human epidermal growth factor receptor 2 (HER2)-positive subtype, and extracranial metastases. Patients with HR-positive/HER2-positive disease had the longest OS (median 18 months) and 12.2% were alive at 8 years. Factors associated with shorter OS included older age, lower income, triple-negative subtype, higher grade, and visceral metastases. CONCLUSION Over the last decade, the median OS of patients with brain metastases at initial breast cancer diagnosis remained poor; however, a substantial minority survive 5 or more years, with rates higher in patients with HER2-positive tumors. In addition to tumor subtype, OS varied according to age, extracranial metastases, and sociodemographic factors.
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Affiliation(s)
- Jorge Avila
- Department of Medicine, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
| | - Julieta Leone
- Grupo Oncológico Cooperativo Del Sur (GOCS), Neuquén, Argentina
| | | | - Nancy U Lin
- Medical Oncology, Susan F. Smith Center for Women's Cancer, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - José P Leone
- Medical Oncology, Susan F. Smith Center for Women's Cancer, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Simon AB, Quezada J, Mohyeldin A, Harris J, Shi M, Seyedin S, Sehgal V, Chen AM. Integrating Overall Survival and Tumor Control Probability Models to Predict Local Progression After Brain Metastasis Radiosurgery. Adv Radiat Oncol 2024; 9:101474. [PMID: 38681893 PMCID: PMC11043807 DOI: 10.1016/j.adro.2024.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/04/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Stereotactic radiosurgery (SRS) for brain metastases is frequently prescribed to the maximum tolerated dose to minimize the probability of local progression. However, many patients die from extracranial disease prior to local progression and may not require maximally aggressive treatment. Recently, improvements in models of SRS tumor control probability (TCP) and overall survival (OS) have been made. We predicted that by combining models of OS and TCP, we could better predict the true risk of local progression after SRS than by using TCP modeling alone. Methods and Materials Records of patients undergoing SRS at a single institution were reviewed retrospectively. Using established TCP and OS models, for each patient, the probability of 1-year survival [p ( O S ) ] was calculated, as was the probability of 1-year local progression [p ( L P ) ]) for each treated lesion. Joint-probability was used to combine the models [p ( L P , O S ) = p ( L P ) * p ( O S ) ]. Analyses were conducted at the individual metastasis and whole-patient levels. Fine-Gray regression was used to model p ( L P ) or p ( L P , O S ) on the risk of local progression after SRS, with death as a competing risk. Results At the patient level, 1-year local progression was 0.08 (95% CI, 0.03-0.15), median p ( L P , O S ) was 0.13 (95% CI, 0.07-0.2), and median p ( L P ) was 0.29 (95% CI, 0.22-0.38). At the metastasis level, 1-year local progression was 0.02 (95% CI, 0.01-0.04), median p ( L P , O S ) was 0.05 (95% CI, 0.02-0.07), and median p ( L P ) was 0.10 (95% CI, 0.07-0.13). p ( L P , O S ) was found to be significantly associated with the risk of local progression at the patient level (P = .048) and metastasis level (P = .007); however, p ( L P ) was not (P = .16 and P = .28, respectively). Conclusions Simultaneous modeling of OS and TCP more accurately predicted local progression than TCP modeling alone. Better understanding which patients with brain metastases are at risk of local progression after SRS may help personalize treatment to minimize risk without sacrificing efficacy.
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Affiliation(s)
- Aaron B. Simon
- Department of Radiation Oncology, University of California Irvine, Irvine, California
| | - Jeffrey Quezada
- University of California Irvine School of Medicine, Irvine, California
| | - Ahmed Mohyeldin
- Department of Neurosurgery, University of California Irvine, Irvine, California
| | - Jeremy Harris
- Department of Radiation Oncology, University of California Irvine, Irvine, California
| | - Mengying Shi
- Department of Radiation Oncology, University of California Irvine, Irvine, California
| | - Steven Seyedin
- Department of Radiation Oncology, University of California Irvine, Irvine, California
| | - Varun Sehgal
- Department of Radiation Oncology, University of California Irvine, Irvine, California
| | - Allen M. Chen
- Department of Radiation Oncology, University of California Irvine, Irvine, California
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5
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Poletes C, Amanirad B, Santiago AT, Yan M, Conrad T, Jerzak KJ, Shultz DB. The incidence of brain metastases in breast cancer according to molecular subtype and stage: a 10-year single institution analysis. J Neurooncol 2024:10.1007/s11060-024-04707-1. [PMID: 38740672 DOI: 10.1007/s11060-024-04707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Breast cancer (BC) is the second most common etiology of brain metastases (BrM). We aimed to examine the incidence of BrM among all BC patients presenting to a large tertiary cancer centre over one decade. METHODS We included all BC patients presenting consecutively between 2009 and 2019 and cross referenced that cohort to a radiotherapy database, identifying patients treated for BrM at any time following their initial presentation. Cumulative incidences (CI) of BrM diagnoses were calculated using death as a competing risk and compared using the Fine-Gray method. Overall survival was estimated using the Kaplan Meier method. RESULTS We identified 12,995 unique patients. The CI of BrM in patients who initially presented with Stage 0-4 disease was 2.1%, 3.7%, 9.4%, 10.6%, and 28.7%, respectively at 10 years. For 8,951 patients with available molecular subtype data, 6,470 (72%), 961 (11%), 1,023 (11%), and 497 (6%) had hormone-receptor (HR)-positive/ERBB2-, HR-negative/ERBB2-, HR-positive/ERBB2 + , and HR-negative/ERBB2 + disease, respectively; the CI of BrM in each was 7.6%, 25.3%, 24.1%, and 26.6%, at 10 years following BC diagnosis, respectively. Median overall survival (OS) following BC diagnosis and BrM diagnosis was 28 years 95% CI [25, 32] and 10 months 95% CI [9, 12], respectively. CONCLUSIONS From a large, registry-based study, we observed that patients with ERBB2 + and triple negative BC have the highest incidence of BrM. Our data supports prospective surveillance brain MRI studies. Given advancements in BrM treatment, clinicians should have a low threshold for brain imaging in BC patients with high risk subtypes.
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Affiliation(s)
- Christopher Poletes
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Bardia Amanirad
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anna T Santiago
- Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Michael Yan
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tatiana Conrad
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Katarzyna J Jerzak
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - David B Shultz
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Mashiach E, Alzate JD, De Nigris Vasconcellos F, Adams S, Santhumayor B, Meng Y, Schnurman Z, Donahue BR, Bernstein K, Orillac C, Bollam R, Kwa MJ, Meyers M, Oratz R, Novik Y, Silverman JS, Harter DH, Golfinos JG, Kondziolka D. Improved outcomes for triple negative breast cancer brain metastases patients after stereotactic radiosurgery and new systemic approaches. J Neurooncol 2024; 168:99-109. [PMID: 38630386 DOI: 10.1007/s11060-024-04651-0] [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: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 05/15/2024]
Abstract
PURPOSE Although ongoing studies are assessing the efficacy of new systemic therapies for patients with triple negative breast cancer (TNBC), the overwhelming majority have excluded patients with brain metastases (BM). Therefore, we aim to characterize systemic therapies and outcomes in a cohort of patients with TNBC and BM managed with stereotactic radiosurgery (SRS) and delineate predictors of increased survival. METHODS We used our prospective patient registry to evaluate data from 2012 to 2023. We included patients who received SRS for TNBC-BM. A competing risk analysis was conducted to assess local and distant control. RESULTS Forty-three patients with 262 tumors were included. The median overall survival (OS) was 16 months (95% CI 13-19 months). Predictors of increased OS after initial SRS include Breast GPA score > 1 (p < 0.001) and use of immunotherapy such as pembrolizumab (p = 0.011). The median time on immunotherapy was 8 months (IQR 4.4, 11.2). The median time to new CNS lesions after the first SRS treatment was 17 months (95% CI 12-22). The cumulative rate for development of new CNS metastases after initial SRS at 6 months, 1 year, and 2 years was 23%, 40%, and 70%, respectively. Thirty patients (70%) underwent multiple SRS treatments, with a median time of 5 months (95% CI 0.59-9.4 months) for the appearance of new CNS metastases after second SRS treatment. CONCLUSIONS TNBC patients with BM can achieve longer survival than might have been previously anticipated with median survival now surpassing one year. The use of immunotherapy is associated with increased median OS of 23 months.
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Affiliation(s)
- Elad Mashiach
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA.
| | - Juan Diego Alzate
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | | | - Sylvia Adams
- Perlmutter Cancer Center, NYU Langone Health, New York University, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York University, New York, NY, USA
| | - Brandon Santhumayor
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - Ying Meng
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - Zane Schnurman
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - Bernadine R Donahue
- Department of Radiation Oncology, NYU Langone Health, New York University, New York, NY, USA
- Maimonides Cancer Center, Maimonides Health, Brooklyn, NY, 11220, USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Health, New York University, New York, NY, USA
| | - Cordelia Orillac
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - Rishitha Bollam
- Perlmutter Cancer Center, NYU Langone Health, New York University, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York University, New York, NY, USA
| | - Maryann J Kwa
- Perlmutter Cancer Center, NYU Langone Health, New York University, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York University, New York, NY, USA
| | - Marleen Meyers
- Perlmutter Cancer Center, NYU Langone Health, New York University, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York University, New York, NY, USA
| | - Ruth Oratz
- Perlmutter Cancer Center, NYU Langone Health, New York University, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York University, New York, NY, USA
| | - Yelena Novik
- Perlmutter Cancer Center, NYU Langone Health, New York University, New York, NY, USA
- Department of Medicine, NYU Langone Health, New York University, New York, NY, USA
| | - Joshua S Silverman
- Department of Radiation Oncology, NYU Langone Health, New York University, New York, NY, USA
| | - David H Harter
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - John G Golfinos
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA
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Huang J, Sun S, Tan Q, Zheng F, Zhou D, Man X, Hu Y, Li W, Song L, Zhang B, Xu L, Wang X, Xie X, Li H. Effectiveness and Safety of Pyrotinib-Based Therapy in the Treatment of HER2-Positive Breast Cancer Patients with Brain Metastases: A Multicenter Real-World Study. Clin Breast Cancer 2024:S1526-8209(24)00101-0. [PMID: 38729821 DOI: 10.1016/j.clbc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Approximately 30% to 50% of patients with human epidermal growth factor receptor 2-positive metastatic breast cancer develop brain metastasis (BMs). Pyrotinib has shown promising efficacy in these patients. However, real-world evidence supporting its use is scarce. Therefore, we evaluate the efficacy and safety of pyrotinib-based regimens in the real world. MATERIALS AND METHODS We enrolled patients with BMs from various healthcare facilities in China's Shandong region and used an updated breast-graded prognostic assessment (breast-GPA) to predict survival outcomes. RESULTS Efficacy and toxicity were assessed in 101 patients. Overall, the median progression-free survival (PFS) was 11.0 months (95% CI, 7.6-14.4 months). PFS was shorter in patients with a breast-GPA of 0 to 2.0 (P< .001). Previous treatment with pertuzumab plus trastuzumab (P = .039) and varying numbers of BMs (P = .028) had a significant positive correlation with PFS. Additionally, radiotherapy (P = .033) for BMs, especially pyrotinib concurrent with radiotherapy (P = .013), significantly prolonged the PFS. In patients with a breast-GPA of 0 to 2.0, a significant difference in PFS was observed depending on whether the brain was the first metastatic site (P< .001). Furthermore, a breast-GPA (0-2.0 vs. 2.5-4.0), and radiotherapy for BMs were found to be independent predictors of PFS. Overall, the objective response rate was 42.6%, while the disease control rate was 88.1%. Diarrhea emerged as the most common adverse event. CONCLUSION Pyrotinib-based therapy is effective and tolerable in human epidermal growth factor receptor 2-positive metastatic breast cancer with BMs. Patients who underwent radiotherapy for BMs, particularly those who received pyrotinib concurrently with radiotherapy, exhibited a more favorable prognosis.
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Affiliation(s)
- Jie Huang
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Shujuan Sun
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Qiaorui Tan
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Fangchao Zheng
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Dongdong Zhou
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Xiaochu Man
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Yu Hu
- Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Wenhuan Li
- Department of Chemotherapy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Lihua Song
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Baoxuan Zhang
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Liang Xu
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | - Xinzhao Wang
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China
| | | | - Huihui Li
- Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250017, China.
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Borm KJ, Behzadi ST, Hörner-Rieber J, Krug D, Baumann R, Corradini S, Duma MN, Dunst J, Fastner G, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Matuschek C, Piroth MD, Schmeel LC, Souchon R, Strnad V, Budach W, Combs SE. DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer. Strahlenther Onkol 2024; 200:259-275. [PMID: 38488902 DOI: 10.1007/s00066-024-02202-0] [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: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The aim of this review was to evaluate the existing evidence for radiotherapy for brain metastases in breast cancer patients and provide recommendations for the use of radiotherapy for brain metastases and leptomeningeal carcinomatosis. MATERIALS AND METHODS For the current review, a PubMed search was conducted including articles from 01/1985 to 05/2023. The search was performed using the following terms: (brain metastases OR leptomeningeal carcinomatosis) AND (breast cancer OR breast) AND (radiotherapy OR ablative radiotherapy OR radiosurgery OR stereotactic OR radiation). CONCLUSION AND RECOMMENDATIONS Despite the fact that the biological subtype of breast cancer influences both the occurrence and relapse patterns of breast cancer brain metastases (BCBM), for most scenarios, no specific recommendations regarding radiotherapy can be made based on the existing evidence. For a limited number of BCBM (1-4), stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (SRT) is generally recommended irrespective of molecular subtype and concurrent/planned systemic therapy. In patients with 5-10 oligo-brain metastases, these techniques can also be conditionally recommended. For multiple, especially symptomatic BCBM, whole-brain radiotherapy (WBRT), if possible with hippocampal sparing, is recommended. In cases of multiple asymptomatic BCBM (≥ 5), if SRS/SRT is not feasible or in disseminated brain metastases (> 10), postponing WBRT with early reassessment and reevaluation of local treatment options (8-12 weeks) may be discussed if a HER2/Neu-targeting systemic therapy with significant response rates in the central nervous system (CNS) is being used. In symptomatic leptomeningeal carcinomatosis, local radiotherapy (WBRT or local spinal irradiation) should be performed in addition to systemic therapy. In patients with disseminated leptomeningeal carcinomatosis in good clinical condition and with only limited or stable extra-CNS disease, craniospinal irradiation (CSI) may be considered. Data regarding the toxicity of combining systemic therapies with cranial and spinal radiotherapy are sparse. Therefore, no clear recommendations can be given, and each case should be discussed individually in an interdisciplinary setting.
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Affiliation(s)
- Kai J Borm
- TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sophie T Behzadi
- TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rene Baumann
- Department of Radiation Oncology, St. Marien-Krankenhaus, Siegen, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, Helios Clinics of Schwerin-University Campus of MSH Medical School Hamburg, Schwerin, Germany
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, University Hospital Salzburg, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - Petra Feyer
- Formerly Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Wulf Haase
- Formerly Department of Radiation Oncology, St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - Wolfgang Harms
- Department of Radiation Oncology, St. Claraspital, Basel, Switzerland
| | - Thomas Hehr
- Department of Radiation Oncology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marc D Piroth
- Department of Radiation Oncology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | - Rainer Souchon
- Formerly Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephanie E Combs
- TUM School of Medicine, Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany.
- Department of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Neuherberg, Germany.
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Cil T, Boileau JF, Chia S, DeCoteau MJ, Jerzak KJ, Koch A, Nixon N, Quan ML, Roberts A, Brezden-Masley C. The Canadian Breast Cancer Symposium 2023 Meeting Report. Curr Oncol 2024; 31:1774-1802. [PMID: 38668038 PMCID: PMC11049169 DOI: 10.3390/curroncol31040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/28/2024] Open
Abstract
On 15-16 June 2023, healthcare professionals and breast cancer patients and advocates from across Canada met in Toronto, Ontario, for the 2023 Canadian Breast Cancer Symposium (CBSC.). The CBSC. is a national, multidisciplinary event that occurs every 2 years with the goal of developing a personalized approach to the management of breast cancer in Canada. Experts provided state-of-the-art information to help optimally manage breast cancer patients, including etiology, prevention, diagnosis, experimental biology, and therapy of breast cancer and premalignant breast disease. The symposium also had the objectives of increasing communication and collaboration among breast cancer healthcare providers nationwide and providing a comprehensive and real-life review of the many facets of breast cancer. The sessions covered the patient voice, the top breast cancer papers from different disciplines in 2022, artificial intelligence in breast cancer, systemic therapy updates, the management of central nervous system metastases, multidisciplinary management of ductal carcinoma in situ, special populations, optimization-based individual prognostic factors, toxicity management of novel therapeutics, survivorship, and updates in surgical oncology. The key takeaways of these sessions have been summarized in this conference report.
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Affiliation(s)
- Tulin Cil
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | | | - Stephen Chia
- British Columbia Cancer Centre, University of British Columbia, Vancouver, BC V5Z 4E6, Canada;
| | - MJ DeCoteau
- Rethink Breast Cancer, Toronto, ON M4M 3G3, Canada;
| | - Katarzyna J. Jerzak
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
| | - Anne Koch
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (T.C.); (A.K.)
| | - Nancy Nixon
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - May Lynn Quan
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada; (N.N.); (M.L.Q.)
| | - Amanda Roberts
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.J.J.); (A.R.)
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10
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Fushimi C, Takahashi H, Kawakita D, Kano S, Tsukahara K, Ozawa H, Okami K, Sakai A, Yamazaki K, Okada T, Hanazawa T, Sato Y, Imanishi Y, Shimizu A, Matsuki T, Nagao T, Tada Y. Brain metastases in patients with salivary duct carcinoma: A retrospective study. Cancer Med 2024; 13:e7037. [PMID: 38477487 DOI: 10.1002/cam4.7037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Salivary duct carcinoma (SDC) is a high-grade adenocarcinoma with a 5-year survival rate of 40%. Although drug therapy has improved patients' prognosis, the impact of brain metastasis (BM) remains poorly understood. We aimed to retrospectively examine the incidence of BM in patients with SDC (n = 464) and develop a tool to estimate their prognoses. METHODS We retrospectively examined 464 patients with SDC enrolled in a multicenter study. We investigated the incidence of BM, overall survival (OS) rates, and factors affecting prognosis in patients with BM. We also developed an SDC-graded prognostic assessment (GPA) score for disease prognostication. RESULTS Sixty-five (14%) patients had BM. The median OS (mOS) was 13.1 months. On univariate and multivariate analyses, factors such as Eastern Cooperative Oncology Group Performance Status >1, human epidermal growth factor receptor 2-negative status, and locoregional uncontrolled disease were associated with poor OS. SDC-GPA scores according to the prognostic factors were 0, 1, 2, and 3 points, and mOS estimates were 50.5, 16.1, 3.9, and 1.2 months, respectively (p < 0.001). CONCLUSION The SDC-GPA score emerged as a useful prognostication tool for patients with BM.
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Affiliation(s)
- Chihiro Fushimi
- Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hideaki Takahashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Kano
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Okami
- Department of Otolaryngology Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Akihiro Sakai
- Department of Otolaryngology Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Keisuke Yamazaki
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Takuro Okada
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Toyoyuki Hanazawa
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichiro Sato
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yorihisa Imanishi
- Otorhinolaryngology, Head and Neck Surgery, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - Akira Shimizu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takashi Matsuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Yuichiro Tada
- Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
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11
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Cacho-Díaz B, Tripathy D, Arrieta VA, Escamilla-Ramirez A, Alvarado-Miranda A, Rodríguez-Mayoral O. Real-World Experience in Hispanic Patients With Breast Cancer and Brain Metastases Using Different Prognostic Tools. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00305-5. [PMID: 38364945 DOI: 10.1016/j.ijrobp.2024.01.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/29/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Only a small percentage of Hispanic patients have been included in studies that developed prognostic models for breast cancer and brain metastases. Therefore, there is a clear need for tools tailored to this demographic. This study assesses the efficacy of common prognostic tools in a Hispanic population. METHODS AND MATERIALS We retrospectively analyzed a data set of Hispanic patients with breast cancer and newly diagnosed brain metastases from 2009 to 2023 at a single referral center. For each prognostic tool, Kaplan-Meier curves were built. The performances of the models were compared using the area under the curve (AUC), C-statistic, and Akaike information criteria (AIC). RESULTS Of 492 patients, the median time from breast cancer to brain metastasis diagnosis was 22.7 months (IQR, 12.1-53.3). The median overall survival was 11.6 months (95% CI, 9.9-13.4). All models were validated as prognostic tools (P < .001). The model with the better performance was the breast graded prognostic assessment (GPA; AIC, 402; AUC, 0.65), followed by the modified GPA (AIC, 406; AUC, 0.64), the disease-specific GPA (AIC, 407; AUC, 0.62), recursive partitioning analysis (AIC, 421; AUC, 0.62), and GPA (AIC, 422; AUC, 0.60). CONCLUSIONS The breast GPA demonstrated superior accuracy in prognosticating outcomes for Hispanic patients with breast cancer and brain metastases. This underscores the critical importance of incorporating racial and ethnic diversity in creating and validating medical prognostic tools.
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Affiliation(s)
- Bernardo Cacho-Díaz
- Neuro-Oncology Unit, Instituto Nacional de Cancerologia, Mexico City, Mexico.
| | - Debu Tripathy
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor A Arrieta
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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12
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Buczek D, Zaucha R, Jassem J. Neurotoxicity-sparing radiotherapy for brain metastases in breast cancer: a narrative review. Front Oncol 2024; 13:1215426. [PMID: 38370347 PMCID: PMC10869626 DOI: 10.3389/fonc.2023.1215426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/19/2023] [Indexed: 02/20/2024] Open
Abstract
Breast cancer brain metastasis (BCBM) has a devastating impact on patient survival, cognitive function and quality of life. Radiotherapy remains the standard management of BM but may result in considerable neurotoxicity. Herein, we describe the current knowledge on methods for reducing radiation-induced cognitive dysfunction in patients with BCBM. A better understanding of the biology and molecular underpinnings of BCBM, as well as more sophisticated prognostic models and individualized treatment approaches, have appeared to enable more effective neuroprotection. The therapeutic armamentarium has expanded from surgery and whole-brain radiotherapy to stereotactic radiosurgery, targeted therapies and immunotherapies, used sequentially or in combination. Advances in neuroimaging have allowed more accurate screening for intracranial metastases, precise targeting of intracranial lesions and the differentiation of the effects of treatment from disease progression. The availability of numerous treatment options for patients with BCBM and multidisciplinary approaches have led to personalized treatment and improved therapeutic outcomes. Ongoing studies may define the optimal sequencing of available and emerging treatment options for patients with BCBM.
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13
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Xu H, Wang Y, Li L, Han Y, Wu Y, Sa Q, Xu B, Wang J. New insights into HER2-low breast cancer brain metastasis: A retrospective analysis. Breast 2024; 73:103669. [PMID: 38176304 PMCID: PMC10791565 DOI: 10.1016/j.breast.2023.103669] [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: 07/07/2023] [Revised: 11/17/2023] [Accepted: 12/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A considerable number of patients with breast cancer will suffer from brain metastasis in the advanced setting. The HER2 status serves as a significant prognostic factor and the reference of applying treatment for patients with breast cancer brain metastasis (BCBM). METHODS Between January 2010 and July 2021, patients with BCBM who had available HER2 status were identified. The patients with HER2 1+ in immunohistochemistry (IHC) or IHC 2+ and fluorescence in situ hybridization (FISH) negative were categorized as HER2-low. Comparisons were conducted between the HER2-low and HER2-zero population. The primary endpoint was overall survival (OS) after the diagnosis of BCBM. Survival outcomes were assessed using Kaplan-Meier curves with log-rank test and Cox proportional hazards model. RESULTS In this study, we analyzed 71 patients with the HER2-low breast cancer subtype and 64 patients with the HER2-zero subtype. Despite the limited sample size, our findings revealed a significantly better OS for patients with HER2-low cancer compared to their HER2-zero counterparts (26 m vs 20 m, p = 0.0017). This trend was particularly notable in the HR-negative group (26 m vs 13 m, p = 0.0078), whereas no significant difference was observed among the HR-positive patients. Furthermore, Cox regression analysis revealed that the HER2-low status was an independent prognostic factor for better survival in the HR-negative patients (p = 0.046 in multivariate analysis). CONCLUSIONS Patients diagnosed with HER2-low BCBM exhibited a more favorable prognosis than those with HER2-zero BCBM, particularly within the HR-negative subgroup. The low expression of HER2 is supposed to be linked to the prolonged survival of BCBM patients.
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Affiliation(s)
- Hangcheng Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yan Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Li Li
- Department of Medical Records, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yiqun Han
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yun Wu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Qiang Sa
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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14
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Goldberg M, Mondragon-Soto MG, Dieringer L, Altawalbeh G, Pöser P, Baumgart L, Wiestler B, Gempt J, Meyer B, Aftahy AK. Navigating Post-Operative Outcomes: A Comprehensive Reframing of an Original Graded Prognostic Assessment in Patients with Brain Metastases. Cancers (Basel) 2024; 16:291. [PMID: 38254781 PMCID: PMC10813622 DOI: 10.3390/cancers16020291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Graded Prognostic Assessment (GPA) has been proposed for various brain metastases (BMs) tailored to the primary histology and molecular profiles. However, it does not consider whether patients have been operated on or not and does not include surgical outcomes as prognostic factors. The residual tumor burden (RTB) is a strong predictor of overall survival. We validated the GPA score and introduced "volumetric GPA" in the largest cohort of operated patients and further explored the role of RTB as an additional prognostic factor. METHODS A total of 630 patients with BMs between 2007 and 2020 were included. The four GPA components were analyzed. The validity of the original score was assessed using Cox regression, and a modified index incorporating RTB was developed by comparing the accuracy, sensitivity, specificity, F1-score, and AUC parameters. RESULTS GPA categories showed an association with survival: age (p < 0.001, hazard ratio (HR) 2.9, 95% confidence interval (CI) 2.5-3.3), Karnofsky performance status (KPS) (p < 0.001, HR 1.3, 95% CI 1.2-1.5), number of BMs (p = 0.019, HR 1.4, 95% CI 1.1-1.8), and the presence of extracranial manifestation (p < 0.001, HR 3, 95% CI 1.6-2.5). The median survival for GPA 0-1 was 4 months; for GPA 1.5-2, it was 12 months; for GPA 2.5-3, it was 21 months; and for GPA 3.5-4, it was 38 months (p < 0.001). RTB was identified as an independent prognostic factor. A cut-off of 2 cm3 was used for further analysis, which showed a median survival of 6 months (95% CI 4-8) vs. 13 months (95% CI 11-14, p < 0.001) for patients with RTB > 2 cm3 and <2 cm3, respectively. RTB was added as an additional component for a modified volumetric GPA score. The survival rates with the modified GPA score were: GPA 0-1: 4 months, GPA 1.5-2: 7 months, GPA 2.5-3: 18 months, and GPA 3.5-4: 34 months. Both scores showed good stratification, with the new score showed a trend towards better discrimination in patients with more favorable prognoses. CONCLUSION The prognostic value of the original GPA was confirmed in our cohort of patients who underwent surgery for BM. The RTB was identified as a parameter of high prognostic significance and was incorporated into an updated "volumetric GPA". This score provides a novel tool for prognosis and clinical decision making in patients undergoing surgery. This method may be useful for stratification and patient selection for further treatment and in future clinical trials.
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Affiliation(s)
- Maria Goldberg
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, 80333 Munich, Germany; (L.D.); (G.A.); (B.M.); (A.K.A.)
| | - Michel G. Mondragon-Soto
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City 14269, Mexico;
| | - Laura Dieringer
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, 80333 Munich, Germany; (L.D.); (G.A.); (B.M.); (A.K.A.)
| | - Ghaith Altawalbeh
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, 80333 Munich, Germany; (L.D.); (G.A.); (B.M.); (A.K.A.)
| | - Paul Pöser
- Department of Neurosurgery, Charite–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Lea Baumgart
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, 80333 Munich, Germany;
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, 80333 Munich, Germany; (L.D.); (G.A.); (B.M.); (A.K.A.)
| | - Amir Kaywan Aftahy
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, 80333 Munich, Germany; (L.D.); (G.A.); (B.M.); (A.K.A.)
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15
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Bansal R, Van Swearingen AED, Anders CK. Triple Negative Breast Cancer and Brain Metastases. Clin Breast Cancer 2023; 23:825-831. [PMID: 37586926 DOI: 10.1016/j.clbc.2023.07.008] [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: 03/31/2023] [Revised: 07/11/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
The treatment of metastatic breast cancer (MBC) has improved over the past decade, however prognosis continues to be mitigated by the fact that about 1 in 5 patients with MBC will develop brain metastases (BrM) during their metastatic disease course. 1 This number is even higher for patients with triple-negative breast cancer (TNBC), with studies showing as high as 40% of patients developing BrM. 2, 3 Studies have shown that TNBC portends a worse survival after a diagnosis of BrM compared with non-TNBC subtypes. 4 Given the unique location and biologic properties of BrM, treatment options have historically been limited. Challenges to the treatment of TNBC BrM include a lack of targeted therapies and difficulties in delivery of drug to the brain past the blood-brain barrier (BBB). Herein, we will review the advances in local and systemic therapies to most effectively treat patients with TNBC BrM, including therapies on the horizon currently in clinical trials.
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Affiliation(s)
- Rani Bansal
- Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Amanda E D Van Swearingen
- Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, Duke Center for Brain and Spine Metastasis, Duke University Medical Center, Durham, NC
| | - Carey K Anders
- Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, Duke Center for Brain and Spine Metastasis, Duke University Medical Center, Durham, NC.
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16
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Giordano G, Griguolo G, Landriscina M, Meattini I, Carbone F, Leone A, Del Re M, Fogli S, Danesi R, Colamaria A, Dieci MV. Multidisciplinary management of HER2-positive breast cancer with brain metastases: An evidence-based pragmatic approach moving from pathophysiology to clinical data. Crit Rev Oncol Hematol 2023; 192:104185. [PMID: 37863404 DOI: 10.1016/j.critrevonc.2023.104185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
INTRODUCTION About 30-50 % of stage IV HER2+ breast cancers (BC) will present brain metastases (BMs). Their management is based on both local treatment and systemic therapy. Despite therapeutic advances, BMs still impact on survival and quality of life and the development of more effective systemic therapies represents an unmet clinical need. MATERIALS AND METHODS A thorough analysis of the published literature including ongoing clinical trials has been performed, investigating concepts spanning from the pathophysiology of tumor microenvironment to clinical considerations with the aim to summarize the current and future locoregional and systemic strategies. RESULTS Different trials have investigated monotherapies and combination treatments, highlighting how the blood-brain barrier (BBB) represents a major problem hindering diffusion and consequently efficacy of such options. Trastuzumab has long been the mainstay of systemic therapy and over the last two decades other HER2-targeted agents including lapatinib, pertuzumab, and trastuzumab emtansine, as well as more recently neratinib, tucatinib, and trastuzumab deruxtecan, have been introduced in clinical practice after showing promising results in randomized controlled trials. CONCLUSIONS We ultimately propose an evidence-based treatment algorithm for clinicians treating HER2 + BCs patients with BMs.
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Affiliation(s)
- Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences - Policlinico Riuniti, University of Foggia, Foggia 71122, Italy.
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova 35128, Italy; Division of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova 35128, Italy
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences - Policlinico Riuniti, University of Foggia, Foggia 71122, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences M Serio, University of Florence, Florence, Italy, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Francesco Carbone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruher Neurozentrum, Karlsruhe 76133, Germany
| | - Augusto Leone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruher Neurozentrum, Karlsruhe 76133, Germany; Faculty of Human Medicine, Charité Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Marzia Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Fogli
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Colamaria
- Division of Neurosurgery, Policlinico Riuniti Foggia, Foggia 71122, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova 35128, Italy; Division of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova 35128, Italy
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Garcia-Saenz JA, Blancas I, Echavarria I, Hinojo C, Margeli M, Moreno F, Pernas S, Ramon y Cajal T, Ribelles N, Bellet M. SEOM-GEICAM-SOLTI clinical guidelines in advanced breast cancer (2022). Clin Transl Oncol 2023; 25:2665-2678. [PMID: 37148499 PMCID: PMC10425299 DOI: 10.1007/s12094-023-03203-8] [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: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/08/2023]
Abstract
Advanced breast cancer represents a challenge for patients and for physicians due its dynamic genomic changes yielding to a resistance to treatments. The main goal is to improve quality of live and survival of the patients through the most appropriate subsequent therapies based on the knowledge of the natural history of the disease. In these guidelines, we summarize current evidence and available therapies for the medical management of advanced breast cancer.
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Affiliation(s)
- Jose Angel Garcia-Saenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Isabel Blancas
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada) and Medicine Departmen, Granada University, Granada, Spain
| | - Isabel Echavarria
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CIBERONC, Madrid, Spain
| | - Carmen Hinojo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Mireia Margeli
- Institut Català d’Oncologia (ICO)-Badalona (Hospital Germans Trias i Pujol), B-ARGO (Badalona Applied Research Group in Oncology) and CARE (Translational Program in Cancer Research), Badalona, Spain
| | - Fernando Moreno
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Sonia Pernas
- Institut Català d’Oncologia (ICO)-L’Hospitalet, Institut d’Investigacio Biomedica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Nuria Ribelles
- UGCI Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria (IBIMA), Málaga, Spain
| | - Meritxell Bellet
- Hospital Universitario Vall D’Hebron, and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
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18
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Id Said B, Soliman H, Moravan V, Myrehaug S, Tseng CL, Detsky J, Sahgal A, Warner E, Jerzak KJ. Patterns of treatment and outcomes of patients with brain-only metastatic breast cancer. J Neurooncol 2023; 164:437-445. [PMID: 37634217 DOI: 10.1007/s11060-023-04421-4] [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: 07/05/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND We characterized the risk factors and survival of metastatic breast cancer (MBC) patients with brain metastases (BrM) as the first and only site of disease in a large, retrospective cohort. METHODS MBC patients treated for BrM with radiation at a quaternary institution between 2005 and 2019 were identified. MBC patients with BrM but without concurrent extracranial metastases (ECM) or leptomeningeal disease (LMD) were classified as brain-only. Factors associated with brain-only MBC, brain-specific progression free survival (bsPFS) and overall survival (OS) were investigated. RESULTS A total of 691 patients with MBC and BrM were analyzed. Among them, 67 patients (9.7%, n = 67/691) presented with brain-only MBC without concurrent ECM/LMD. Within this subgroup, 40 patients (5.8%, n = 40/691) remained free of any ECM or LMD, while 17 patients (2.5%) developed LMD, and 10 patients (1.4%%) developed ECM with a median follow-up of 8 months (IQR 2-35). Patients with brain-only MBC were more likely to have a single BrM [OR 3.41 (1.62-7.19), p = 0.001] and either HER2+ [OR 3.3 (1.13-9.65), p = 0.03] or TNBC [OR 4.09 (1.42-11.74), p = 0.009] subtypes. Patients who presented with brain-only MBC also had significantly longer OS [HR 0.45, (0.22-0.86), p = 0.008] and a trend toward longer bsPFS [HR 0.67 (0.44-1.03), p = 0.05] compared to those with concurrent ECM/LMD. CONCLUSION Patients with brain-only MBC had a longer bsPFS and OS than those with ECM. Patients with HER2+ and TNBC were more likely to have brain-only disease compared to those with HR+/HER2- MBC.
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Affiliation(s)
- Badr Id Said
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | | | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Ellen Warner
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Katarzyna J Jerzak
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
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19
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Xu F, Ou D, Qi W, Wang S, Han Y, Cai G, Cao L, Xu C, Chen JY. Impact of multidisciplinary team on the pattern of care for brain metastasis from breast cancer. Front Oncol 2023; 13:1160802. [PMID: 37664027 PMCID: PMC10471195 DOI: 10.3389/fonc.2023.1160802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose The aim of this study was to explore how a multidisciplinary team (MDT) affects patterns of local or systematic treatment. Methods We retrospectively reviewed the data of consecutive patients in the breast cancer with brain metastases (BCBM) database at our institution from January 2011 to April 2021. The patients were divided into an MDT group and a non-MDT group. Results A total of 208 patients were analyzed, including 104 each in the MDT and non-MDT groups. After MDT, 56 patients (53.8%) were found to have intracranial "diagnosis upgrade". In the matched population, patients in the MDT group recorded a higher proportion of meningeal metastases (14.4% vs. 4.8%, p = 0.02), symptomatic tumor progression (11.5% vs. 5.8%, p = 0.04), and an increased number of occurrences of brain metastases (BM) progression (p < 0.05). Attending MDT was an independent factor associated with ≥2 courses of intracranial radiotherapy (RT) [odds ratio (OR) 5.4, 95% confidence interval (CI): 2.7-10.9, p < 0.001], novel RT technique use (7.0, 95% CI 3.5-14.0, p < 0.001), and prospective clinical research (OR 5.7, 95% CI 2.4-13.4, p < 0.001). Conclusion Patients with complex conditions are often referred for MDT discussions. An MDT may improve the qualities of intracranial RT and systemic therapy, resulting in benefits of overall survival for BC patients after BM. This encourages the idea that treatment recommendations for patients with BMBC should be discussed within an MDT.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jia-Yi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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20
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Shi W, Li Y, Sun H, Zhang L, Meng J, Wang X, Chen X, Zhang X, Mei X, Ma J, Mo M, Zhou C, Liang F, Shao Z, Zhang Z, Guo X, Yu X, Yang Z. Favorable prognosis of breast cancer brain metastases patients with limited intracranial and extracranial metastatic lesions. Radiat Oncol 2023; 18:107. [PMID: 37393259 DOI: 10.1186/s13014-023-02293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/30/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Breast cancer brain metastases (BCBM) are highly heterogenous with widely differing survival. The prognosis of the oligometastatic breast cancer (BC) patients with brain metastases (BM) has not been well studied. We aimed to investigate the prognosis of BCBM patients with limited intracranial and extracranial metastatic lesions. METHODS Four hundred and forty-five BCBM patients treated between 1st January 2008 and 31st December 2018 at our institute were included. Clinical characteristics and treatment information were obtained from patient's medical records. The updated breast Graded Prognostic Assessment (Breast GPA) was calculated. RESULTS The median OS after diagnosis of BM were 15.9 months. Median OS for patients with GPA 0-1.0, 1.5-2, 2.5-3 and 3.5-4 were 6.9, 14.2, 21.8, 42.6 months respectively. The total number of intracranial and extracranial metastatic lesions, in addition to the Breast GPA, salvage local therapy and systemic therapy (anti-HER2 therapy, chemotherapy and endocrine therapy) were demonstrated to be associated with prognosis. One hundred and thirteen patients (25.4%) had 1-5 total metastatic lesions at BM diagnosis. Patients with 1-5 total metastatic lesions had a significantly longer median OS of 24.3 months compared to those with greater than 5 total metastatic lesions with a median OS of 12.2 months (P < 0.001; multivariate HR 0.55, 95% CI, 0.43-0.72). Among the patients with 1-5 metastatic lesions, median OS for GPA 0-1.0 was 9.8 months, compared to 22.8, 28.8 and 71.0 for GPA 1.5-2.0, 2.5-3.0 and 3.5-4.0 respectively, which is much longer than the corresponding patients with greater than 5 total metastatic lesions, with medium OS of 6.8, 11.6, 18.6 and 42.6 months respectively for GPA 0-1.0, 1.5-2.0, 2.5-3.0 and 3.5-4.0. CONCLUSIONS The patients with 1-5 total metastatic lesions demonstrated better OS. The prognostic value of the Breast GPA and the survival benefit of salvage local therapy and continuation of systemic therapy after BM were confirmed.
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Affiliation(s)
- Wei Shi
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Yang Li
- Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Hua Sun
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Li Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Jin Meng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xiaofang Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xingxing Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xiaomeng Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xin Mei
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Jinli Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Miao Mo
- Department of Cancer Prevention and Clinical Statistics Center, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Changming Zhou
- Department of Cancer Prevention and Clinical Statistics Center, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China.
| | - Zhaozhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China.
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Warrior S, Cohen-Nowak A, Kumthekar P. Modern Management and Diagnostics in HER2+ Breast Cancer with CNS Metastasis. Cancers (Basel) 2023; 15:cancers15112908. [PMID: 37296873 DOI: 10.3390/cancers15112908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Patients with HER2-positive breast cancer have seen improved survival and outcomes over the past two decades. As patients live longer, the incidence of CNS metastases has increased in this population. The authors' review outlines the most current data in HER2-positive brain and leptomeningeal metastases and discuss the current treatment paradigm in this disease. Up to 55% of HER2-positive breast cancer patients go on to experience CNS metastases. They may present with a variety of focal neurologic symptoms, such as speech changes or weakness, and may also have more diffuse symptoms related to high intracranial pressure, such as headaches, nausea, or vomiting. Treatment can include focal treatments, such as surgical resection or radiation (focal or whole-brain radiation), as well as systemic therapy options or even intrathecal therapy in the case of leptomeningeal disease. There have been multiple advancements in systemic therapy for these patients over the past few years, including the availability of tucatinib and trastuzumab-deruxtecan. Hope remains high as clinical trials for CNS metastases receive greater attention and as other HER2-directed methods are being studied in clinical trials with the goal of better outcomes for these patients.
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Affiliation(s)
- Surbhi Warrior
- Department of Hematology, Oncology Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | - Adam Cohen-Nowak
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | - Priya Kumthekar
- Department of Neuro-Oncology, Northwestern Memorial Hospital, Chicago, IL 60611, USA
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22
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Akanda MR, Ahn EJ, Kim YJ, Salam SMA, Noh MG, Lee TK, Kim SS, Lee KH, Moon KS. Analysis of stromal PDGFR-β and α-SMA expression and their clinical relevance in brain metastases of breast cancer patients. BMC Cancer 2023; 23:468. [PMID: 37217880 DOI: 10.1186/s12885-023-10957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/13/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Breast cancer brain metastasis (BCBM) is a growing therapeutic challenge and clinical concern. Stromal cancer-associated fibroblasts (CAFs) are crucial factors in the modulation of tumorigeneses and metastases. Herein, we investigated the relationship between the expression of stromal CAF markers in metastatic sites, platelet-derived growth factor receptor-beta (PDGFR-β), and alpha-smooth muscle actin (α-SMA) and the clinical and prognostic variables in BCBM patients. METHODS Immunohistochemistry (IHC) of the stromal expression of PDGFR-β and α-SMA was performed on 50 cases of surgically resected BCBM. The expression of the CAF markers was analyzed in the context of clinico-pathological characteristics. RESULTS Expression of PDGFR-β and α-SMA was lower in the triple-negative (TN) subtype than in other molecular subtypes (p = 0.073 and p = 0.016, respectively). And their expressions were related to a specific pattern of CAF distribution (PDGFR-β, p = 0.009; α-SMA, p = 0.043) and BM solidity (p = 0.009 and p = 0.002, respectively). High PDGFR-β expression was significantly related to longer recurrence-free survival (RFS) (p = 0.011). TN molecular subtype and PDGFR-β expression were independent prognostic factors of recurrence-free survival (p = 0.029 and p = 0.030, respectively) and TN molecular subtype was an independent prognostic factor of overall survival (p < 0.001). CONCLUSIONS Expression of PDGFR-β in the stroma of BM was associated with RFS in BCBM patients, and the clinical implication was uniquely linked to the low expression of PDGFR-β and α-SMA in the aggressive form of the TN subtype.
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Affiliation(s)
- Md Rashedunnabi Akanda
- Department of Pathology, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea
- Department of Pharmacology and Toxicology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Eun-Jung Ahn
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea
| | - Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea
| | - S M Abdus Salam
- Department of Pathology, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea
| | - Myung-Giun Noh
- Department of Pathology, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea
| | - Tae-Kyu Lee
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea
| | - Sung Sun Kim
- Department of Pathology, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea.
- BioMedical Sciences Graduate Program (BMSGP), Chonnam National University, Hwasun, Jeollanam-do, South Korea.
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, 58128, Jeollanam-do, South Korea.
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23
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Chew Minmin S, Bacotti A, Chen Y, Anders C, Sambade M, Deal AM, Trembath D, McKee MJ, Brogi E, Seidman AD. Impact of prior systemic therapy on lymphocytic infiltration in surgically resected breast cancer brain metastases. Breast Cancer Res Treat 2023; 199:99-107. [PMID: 36930347 PMCID: PMC10865424 DOI: 10.1007/s10549-023-06908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/02/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Tumor-infiltrating lymphocytes (TILs) have been positively correlated with response to systemic therapy for triple-negative and HER2 + subtypes and improved clinical outcomes in early breast cancer (BC). Less is known about TILs in metastatic sites, particularly brain metastases (BM), where unique immune regulation governs stromal composition. Reactive glial cells actively participate in cytokine-mediated T cell stimulation. The impact of prior medical therapy (chemotherapy, endocrine, and HER2-targeted therapy) on the presence of TILs and gliosis in human breast cancer brain metastases (BCBM) has not been previously reported. METHODS We examined prior treatment data for 133 patients who underwent craniotomy for resection of BMs from the electronic medical record. The primary endpoint was overall survival (OS) from the time of BM diagnosis. We examined the relationship between prior systemic therapy exposure and the histologic features of gliosis, necrosis, hemorrhage, and lymphocyte infiltration (LI) in BCBMs resected at subsequent craniotomy in univariate analyses. RESULTS Complete treatment data were available for 123 patients. BCBM LI was identified in 35 of 116 (30%) patients who had received prior systemic treatment versus 5 of 7 (71.4%) who had not {significant by Fisher's exact test p = 0.045}. There were no statistically significant relationships between prior systemic therapy and the three other histologic variables examined. CONCLUSIONS This observation suggests that systemic therapy may interfere with the immune response to BCBMs and cause exhaustion of anti-tumor immunity. This motivates clinical investigation of strategies to enhance LI for therapeutic benefit to improve outcomes for patients with BCBMs.
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Affiliation(s)
- S Chew Minmin
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Bacotti
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Y Chen
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Anders
- Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - M Sambade
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A M Deal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Trembath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M J McKee
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Brogi
- Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A D Seidman
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Cornell Medical College, New York, NY, USA.
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24
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Riecke K, Müller V, Neunhöffer T, Park-Simon TW, Weide R, Polasik A, Schmidt M, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Wuerstlein R, Denkert C, Decker T, Fehm T, Nekljudova V, Rey J, Loibl S, Laakmann E, Witzel I. Long-term survival of breast cancer patients with brain metastases: subanalysis of the BMBC registry. ESMO Open 2023; 8:101213. [PMID: 37075697 DOI: 10.1016/j.esmoop.2023.101213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Up to 30% of metastatic breast cancer (BC) patients develop brain metastases (BM). Prognosis of patients with BM is poor and long-term survival is rare. Identification of factors associated with long-term survival is important for improving treatment modalities. PATIENTS AND METHODS A total of 2889 patients of the national registry for BM in BC (BMBC) were available for this analysis. Long-term survival was defined as overall survival (OS) in the upper third of the failure curve resulting in a cut-off of 15 months. A total of 887 patients were categorized as long-term survivors. RESULTS Long-term survivors compared to other patients were younger at BC and BM diagnosis (median 48 versus 54 years and 53 versus 59 years), more often had HER2-positive tumors (59.1% versus 36.3%), less frequently luminal-like (29.1% versus 35.7%) or triple-negative breast cancer (TNBC) (11.9% versus 28.1%), showed better Eastern Cooperative Oncology Group (ECOG) performance status (PS) at the time of BM diagnosis (ECOG 0-1, 76.9% versus 51.0%), higher pathological complete remission rates after neoadjuvant chemotherapy (21.6% versus 13.7%) and lower number of BM (n = 1, BM 40.9% versus 25.4%; n = 2-3, BM 26.5% versus 26.7%; n ≥4, BM 32.6% versus 47.9%) (P < 0.001). Long-term survivors had leptomeningeal metastases (10.4% versus 17.5%) and extracranial metastases (ECM, 73.6% versus 82.5%) less frequently, and asymptomatic BM more often at the time of BM diagnosis (26.5% versus 20.1%), (P < 0.001). Median OS in long-term survivors was about two times higher than the cut-off of 15 months: 30.9 months [interquartile range (IQR) 30.3] overall, 33.9 months (IQR 37.1) in HER2-positive, 26.9 months (IQR 22.0) in luminal-like and 26.5 months (IQR 18.2) in TNBC patients. CONCLUSIONS In our analysis, long-term survival of BC patients with BM was associated with better ECOG PS, younger age, HER2-positive subtype, lower number of BM and less extended visceral metastases. Patients with these clinical features might be more eligible for extended local brain and systemic treatment.
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Affiliation(s)
- K Riecke
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Neunhöffer
- Frauenärzte am Dom, Mainz, Germany; HELIOS Dr. Horst Schmidt Clinic Wiesbaden, Wiesbaden, Germany
| | - T-W Park-Simon
- Hanover Medical School (MHH University), Hanover, Germany
| | - R Weide
- Institute for Health Services Research in Oncology, Koblenz, Germany
| | - A Polasik
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - M Schmidt
- The University Medical Center Mainz, Mainz, Germany
| | - J Puppe
- Department of Obstetrics & Gynecology, University Hospital of Cologne, Cologne, Germany
| | - C Mundhenke
- Klinikum Bayreuth GmbH/Medizincampus Oberfranken, Bayreuth, Germany; Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Erlangen, Germany
| | - K Lübbe
- Diakovere Henriettenstift, Breast Center, Hannover, Germany
| | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - M Thill
- Department of Gynecology and Gyneacological Oncology, Agaplesion Markus Hospital, Frankfurt, Germany
| | - R Wuerstlein
- Department of Obstetrics and Gynecology, Breast Center and CCC Munich, LMU University Hospital, Munich, Germany
| | - C Denkert
- Institute of Pathology, Philipps University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - T Decker
- Onkology, Haematology Ravensburg, Ravensburg, Germany
| | - T Fehm
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - J Rey
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - E Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology, University Hospital Zurich, Zürich, Switzerland.
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25
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Kowalchuk R, Mullikin TC, Breen W, Gits HC, Florez M, De B, Harmsen WS, Rose PS, Siontis BL, Costello BA, Morris JM, Lucido JJ, Olivier KR, Stish B, Laack NN, Park S, Owen D, Ghia AJ, Brown PD, Merrell KW. Development and validation of a unifying pre-treatment decision tool for intracranial and extracranial metastasis-directed radiotherapy. Front Oncol 2023; 13:1095170. [PMID: 37051531 PMCID: PMC10083422 DOI: 10.3389/fonc.2023.1095170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundThough metastasis-directed therapy (MDT) has the potential to improve overall survival (OS), appropriate patient selection remains challenging. We aimed to develop a model predictive of OS to refine patient selection for clinical trials and MDT.Patients and methodsWe assembled a multi-institutional cohort of patients treated with MDT (stereotactic body radiation therapy, radiosurgery, and whole brain radiation therapy). Candidate variables for recursive partitioning analysis were selected per prior studies: ECOG performance status, time from primary diagnosis, number of additional non-target organ systems involved (NOS), and intracranial metastases.ResultsA database of 1,362 patients was assembled with 424 intracranial, 352 lung, and 607 spinal treatments (n=1,383). Treatments were split into training (TC) (70%, n=968) and internal validation (IVC) (30%, n=415) cohorts. The TC had median ECOG of 0 (interquartile range [IQR]: 0-1), NOS of 1 (IQR: 0-1), and OS of 18 months (IQR: 7-35). The resulting model components and weights were: ECOG = 0, 1, and > 1 (0, 1, and 2); 0, 1, and > 1 NOS (0, 1, and 2); and intracranial target (2), with lower scores indicating more favorable OS. The model demonstrated high concordance in the TC (0.72) and IVC (0.72). The score also demonstrated high concordance for each target site (spine, brain, and lung).ConclusionThis pre-treatment decision tool represents a unifying model for both intracranial and extracranial disease and identifies patients with the longest survival after MDT who may benefit most from aggressive local therapy. Carefully selected patients may benefit from MDT even in the presence of intracranial disease, and this model may help guide patient selection for MDT.
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Affiliation(s)
- Roman Kowalchuk
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Trey C. Mullikin
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - William Breen
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - Hunter C. Gits
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - Marcus Florez
- Department of Radiation Oncology, Houston, MD Anderson Cancer Center, Houston, TX, United States
| | - Brian De
- Department of Radiation Oncology, Houston, MD Anderson Cancer Center, Houston, TX, United States
| | | | - Peter Sean Rose
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, United States
| | | | | | - Jonathan M. Morris
- Mayo Clinic, Department of Medical Oncology, Rochester, MN, United States
| | - John J. Lucido
- Mayo Clinic, Department of Medical Physics, Rochester, MN, United States
| | - Kenneth R. Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Brad Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Sean Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Amol J. Ghia
- Department of Radiation Oncology, Houston, MD Anderson Cancer Center, Houston, TX, United States
| | - Paul D. Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Kenneth Wing Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Kenneth Wing Merrell,
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26
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Trapani D, Aizer AA, Lin NU. Multidisciplinary Management of Brain Metastasis from Breast Cancer. Hematol Oncol Clin North Am 2023; 37:183-202. [PMID: 36435610 DOI: 10.1016/j.hoc.2022.08.017] [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] [Indexed: 11/24/2022]
Abstract
The management of patients with breast cancer and brain metastases (BMs) is exquisitely multidisciplinary. Patients presenting with a symptomatic BM may be offered neurosurgical resection, followed by radiation. Stereotactic radiosurgery (SRS) is preferred over whole-brain radiotherapy (WBRT) in most patients presenting with a limited number of BMs, whereas WBRT with hippocampal-sparing and concomitant memantine is preferred for patients with multiple BMs. There is a growing role for systemic therapy, in some cases in lieu of local therapy, particularly in patients with HER2+ breast cancer.
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Affiliation(s)
- Dario Trapani
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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27
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Bottosso M, Griguolo G, Sinoquet L, Guarascio MC, Aldegheri V, Miglietta F, Vernaci G, Barbieri C, Girardi F, Jacot W, Guarneri V, Darlix A, Dieci MV. Prognostic impact of extracranial disease control in HER2+ breast cancer-related brain metastases. Br J Cancer 2023; 128:1286-1293. [PMID: 36717671 PMCID: PMC10049979 DOI: 10.1038/s41416-023-02153-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Brain metastases (BM) are common among HER2+ breast cancer (BC) and prognostic stratification is crucial for optimal management. BC-GPA score and subsequent refinements (modified-GPA, updated-GPA) recapitulate prognostic factors. Since none of these indexes includes extracranial disease control, we evaluated its prognostic value in HER2+ BCBM. METHODS Patients diagnosed with HER2+ BCBM at Istituto Oncologico Veneto-Padova (2002-2021) and Montpellier Cancer Institute (2001-2015) were included as exploratory and validation cohorts, respectively. Extracranial disease control at BM diagnosis (no disease/stable disease/response vs. progressive disease) was evaluated. RESULTS In the exploratory cohort of 113 patients (median OS 12.2 months), extracranial control (n = 65, 57.5%) was significantly associated with better OS at univariate (median OS 17.7 vs. 8.7 months, p = 0.005) and multivariate analysis after adjustment for BC-GPA (HR 0.61, 95% CI 0.39-0.94), modified-GPA (HR 0.64, 95% CI 0.42-0.98) and updated-GPA (HR 0.63, 95% CI 0.41-0.98). The prognostic impact of extracranial disease control (n = 66, 56.4%) was then confirmed in the validation cohort (n = 117) at univariate (median OS 20.2 vs. 9.1 months, p < 0.001) and multivariate analysis adjusting for BC-GPA (HR 0.41, 95% CI 0.27-0.61), modified-GPA (HR 0.44, 95% CI 0.29-0.67) and updated-GPA (HR 0.42, 95% CI 0.28-0.63). CONCLUSIONS Extracranial disease control provides independent prognostic information in HER2+ BCBM beyond commonly used prognostic scores.
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Affiliation(s)
- Michele Bottosso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. .,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
| | - Léa Sinoquet
- Medical Oncology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - Maria Cristina Guarascio
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Grazia Vernaci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Caterina Barbieri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Fabio Girardi
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - William Jacot
- Medical Oncology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Amélie Darlix
- Medical Oncology Department, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France.,Institut de Génomique Fonctionnelle, INSERM, CNRS - University of Montpellier, Montpellier, France
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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28
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Yang X, Ren H, Xu Y, Peng X, Yu W, Shen Z. Combination of radiotherapy and targeted therapy for HER2-positive breast cancer brain metastases. Eur J Med Res 2023; 28:27. [PMID: 36642742 PMCID: PMC9841677 DOI: 10.1186/s40001-022-00894-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/09/2022] [Indexed: 01/17/2023] Open
Abstract
Radiotherapy and targeted therapy are essential treatments for patients with brain metastases from human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, the combination of radiotherapy and targeted therapy still needs to be investigated, and neurotoxicity induced by radiotherapy for brain metastases has also become an important issue of clinical concern. It remained unclear how to achieve the balance of efficacy and toxicity with the application of new radiotherapy techniques and new targeted therapy drugs. This article reviews the benefits and potential risk of combining radiotherapy and targeted therapy for HER2-positive breast cancer with brain metastases.
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Affiliation(s)
- Xiaojing Yang
- grid.16821.3c0000 0004 0368 8293Department of Oncology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yishan Road, Shanghai, 200233 China ,grid.16821.3c0000 0004 0368 8293Department of Radiation Oncology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanru Ren
- grid.8547.e0000 0001 0125 2443Department of Orthopedics, Pudong Medical Center, Shanghai Pudong Hospital, Fudan University, Shanghai, China
| | - Yi Xu
- grid.16821.3c0000 0004 0368 8293Department of Oncology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yishan Road, Shanghai, 200233 China
| | - Xue Peng
- grid.16821.3c0000 0004 0368 8293Department of Breast Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxi Yu
- grid.16821.3c0000 0004 0368 8293Department of Oncology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yishan Road, Shanghai, 200233 China
| | - Zan Shen
- grid.16821.3c0000 0004 0368 8293Department of Oncology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yishan Road, Shanghai, 200233 China
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29
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Minareci Y, Ak N, Tosun OA, Sozen H, Saip PM, Topuz S, Salihoglu MY. Central nervous system metastasis in gynecologic cancers: Seeking the prognostic factors. J Cancer Res Ther 2023; 19:S523-S529. [PMID: 38384014 DOI: 10.4103/jcrt.jcrt_499_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/27/2022] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Central nervous system (CNS) metastasis originating from gynecological cancer is a very rare and late manifestation of the disease. Therefore, there is still limited data on prognostic factors for survival. The objective of the present study is to identify prognostic factors for survival in patients with CNS metastasis originating from gynecological cancer. STUDY DESIGN The present retrospective study analyzed the patients with gynecological cancers who were treated due to CNS metastases between January 1999 and December 2019 at Istanbul University Hospital. RESULTS Forty-seven patients with CNS metastasis of gynecological origin were included in the study. The median age at the time of CNS metastasis was 59 (range 34-93). The median time from initial cancer diagnosis to CNS metastasis was 24.9 (range: 0-108.2) months. Most patients had epithelial ovarian cancer (EOC) (76.6%), followed by endometrial cancer (EC) (14.8%), cervical cancer (CC) (4.3%), and vulvar cancer (VC) (4.3%). By multivariate analysis, the presence of extracranial metastasis (HR: 5.10; 95% CI: 1.71-15.18), Eastern Cooperative Oncology Group (ECOG) performance status ≥3 (HR: 2.92; 95% CI: 1.36-6.26), palliative care only for the treatment of CNS metastasis (HR: 1.47; 95% CI: 0.58-4.11), and treatment-free interval (TFI) <6 months (HR: 2.74; 95% CI: 1.23-6.08) were independent factors that associated with worse survival. CONCLUSION Patients with CNS metastasis who have favorable prognostic factors are considered to be appropriate candidates for aggressive and long-term treatment strategies. Extracranial metastasis, ECOG performance status, treatment history of CNS metastasis, and TFI were determined as independent prognostic factors that improved survival. TFI might be taken into account as a prognostic factor for patients with CNS metastasis in gynecological cancer.
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Affiliation(s)
- Yagmur Minareci
- Department of Gynecologic Oncology, Eskisehir City Hospital, Eskisehir, Turkey
| | - Naziye Ak
- Department of Medical Oncology Istanbul University, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ozgur Aydın Tosun
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Hamdullah Sozen
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pinar Mualla Saip
- Department of Medical Oncology Istanbul University, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Samet Topuz
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Yavuz Salihoglu
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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30
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Ferraro E, Seidman AD. Breast Cancer Brain Metastases: Achilles' Heel in Breast Cancer Patients' Care. Cancer Treat Res 2023; 188:283-302. [PMID: 38175350 DOI: 10.1007/978-3-031-33602-7_11] [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] [Indexed: 01/05/2024]
Abstract
Brain metastases (BM) significantly affect the prognosis as well as the quality of life of breast cancer (BC) patients. Although advancements in neurosurgical and radiotherapy techniques improve local control and symptom management, BM remains associated with a poor prognosis. In addition, the efficacy of currently approved systemic therapies in central nervous system (CNS) compartment is still limited, especially after progression on local therapy. The blood-brain barrier (BBB) has been recognized as a mechanism of primary resistance to many chemotherapeutic agents and targeted therapies due to low drug penetration. Other mechanisms of primary and secondary resistance are still unclear and may vary across the BC subtypes. New small molecules have demonstrated efficacy in BM, in particular for the HER2-positive subtype, with a benefit in survival. A new era has begun in the field of BM, and many trials specifically designed for this population are currently ongoing. The BC research community needs to address this call with the final aim of improving the efficacy of systemic therapy in CNS compartment and ultimately preventing the occurrence of BM.
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Affiliation(s)
- Emanuela Ferraro
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Seidman
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Cornell College of Medicine, New York, NY, USA.
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31
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Tabor JK, Onoichenco A, Narayan V, Wernicke AG, D’Amico RS, Vojnic M. Brain metastasis screening in the molecular age. Neurooncol Adv 2023; 5:vdad080. [PMID: 37484759 PMCID: PMC10358433 DOI: 10.1093/noajnl/vdad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
The incidence of brain metastases (BM) amongst cancer patients has been increasing due to improvements in therapeutic options and an increase in overall survival. Molecular characterization of tumors has provided insights into the biology and oncogenic drivers of BM and molecular subtype-based screening. Though there are currently some screening and surveillance guidelines for BM, they remain limited. In this comprehensive review, we review and present epidemiological data on BM, their molecular characterization, and current screening guidelines. The molecular subtypes with the highest BM incidence are epithelial growth factor receptor-mutated non-small cell lung cancer (NSCLC), BRCA1, triple-negative (TN), and HER2+ breast cancers, and BRAF-mutated melanoma. Furthermore, BMs are more likely to present asymptomatically at diagnosis in oncogene-addicted NSCLC and BRAF-mutated melanoma. European screening standards recommend more frequent screening for oncogene-addicted NSCLC patients, and clinical trials are investigating screening for BM in hormone receptor+, HER2+, and TN breast cancers. However, more work is needed to determine optimal screening guidelines for other primary cancer molecular subtypes. With the advent of personalized medicine, molecular characterization of tumors has revolutionized the landscape of cancer treatment and prognostication. Incorporating molecular characterization into BM screening guidelines may allow physicians to better identify patients at high risk for BM development and improve patient outcomes.
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Affiliation(s)
| | | | - Vinayak Narayan
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - A Gabriella Wernicke
- Department of Radiation Medicine, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Randy S D’Amico
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Morana Vojnic
- Corresponding Author: Morana Vojnic, MD, MBA, 210 East 64th Street, Floor 4, New York, NY 10065, USA ()
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32
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Hintelmann K, Petersen C, Borgmann K. Radiotherapeutic Strategies to Overcome Resistance of Breast Cancer Brain Metastases by Considering Immunogenic Aspects of Cancer Stem Cells. Cancers (Basel) 2022; 15:211. [PMID: 36612206 PMCID: PMC9818478 DOI: 10.3390/cancers15010211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Breast cancer is the most diagnosed cancer in women, and symptomatic brain metastases (BCBMs) occur in 15-20% of metastatic breast cancer cases. Despite technological advances in radiation therapy (RT), the prognosis of patients is limited. This has been attributed to radioresistant breast cancer stem cells (BCSCs), among other factors. The aim of this review article is to summarize the evidence of cancer-stem-cell-mediated radioresistance in brain metastases of breast cancer from radiobiologic and radiation oncologic perspectives to allow for the better interpretability of preclinical and clinical evidence and to facilitate its translation into new therapeutic strategies. To this end, the etiology of brain metastasis in breast cancer, its radiotherapeutic treatment options, resistance mechanisms in BCSCs, and effects of molecularly targeted therapies in combination with radiotherapy involving immune checkpoint inhibitors are described and classified. This is considered in the context of the central nervous system (CNS) as a particular metastatic niche involving the blood-brain barrier and the CNS immune system. The compilation of this existing knowledge serves to identify possible synergistic effects between systemic molecularly targeted therapies and ionizing radiation (IR) by considering both BCSCs' relevant resistance mechanisms and effects on normal tissue of the CNS.
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Affiliation(s)
- Katharina Hintelmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Laboratory of Radiobiology and Experimental Radiooncology, Center of Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Kerstin Borgmann
- Laboratory of Radiobiology and Experimental Radiooncology, Center of Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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33
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Systemic Therapy for Patients with HER2-Positive Breast Cancer and Brain Metastases: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225612. [PMID: 36428705 PMCID: PMC9688214 DOI: 10.3390/cancers14225612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
AIM Patients with HER2-positive (HER2+) metastatic breast cancer (mBC) develop brain metastases (BM) in up to 30% of cases. Treatment of patients with BM can consist of local treatment (surgery and/or radiotherapy) and/or systemic treatment. We undertook a systematic review and meta-analysis to determine the effect of different systemic therapies in patients with HER2+ mBC and BM. METHODS A systematic search was performed in the databases PubMed, Embase.com, Clarivate Analytics/Web of Science Core Collection and the Wiley/Cochrane Library. Eligible articles included prospective or retrospective studies reporting on the effect of systemic therapy on objective response rate (ORR) and/or median progression free survival (mPFS) in patients with HER2+ mBC and BM. The timeframe within the databases was from inception to 19 January 2022. Fixed-effects meta-analyses were used. Quality appraisal was performed using the ROBINS-I tool. RESULTS Fifty-one studies were included, involving 3118 patients. Most studies, which contained the largest patient numbers, but also often carried a moderate-serious risk of bias, investigated lapatinib and capecitabine (LC), trastuzumab-emtansine (T-DM1) or pyrotinib. The best quality data and/or highest ORR were described with tucatinib (combined with trastuzumab and capecitabine, TTC) and trastuzumab-deruxtecan (T-DXd). TTC demonstrated an ORR of 47.3% in patients with asymptomatic and/or active BM. T-DXd achieved a pooled ORR of 64% (95% CI 43-85%, I2 0%) in a heavily pretreated population with asymptomatic BM (3 studies, n = 96). CONCLUSIONS Though our meta-analysis should be interpreted with caution due to the heterogeneity of included studies and a related serious risk of bias, this review provides a comprehensive overview of all currently available systemic treatment options. T-Dxd and TTC that appear to constitute the most effective systemic therapy in patients with HER2+ mBC and BM, while pyrotinib might be an option in Asian patients.
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Alshammari A. Construction of VGG16 Convolution Neural Network (VGG16_CNN) Classifier with NestNet-Based Segmentation Paradigm for Brain Metastasis Classification. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22208076. [PMID: 36298426 PMCID: PMC9606896 DOI: 10.3390/s22208076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/24/2022] [Accepted: 10/11/2022] [Indexed: 06/01/2023]
Abstract
Brain metastases (BMs) happen often in patients with metastatic cancer (MC), requiring initial and precise diagnosis of BMs, which remains important for medical care preparation and radiotherapy prognostication. Nevertheless, the susceptibility of automated BM (ABMS) diagnosis is unfairly great for minute BMs, and integrating into medical exercises to distinguish true metastases (MtS) from false positives remains difficult. For enhancing BM classification execution, MtS localization is performed through the NestNet framework. Subsequent to segmentation, classification is performed by employing the VGG16 convolution neural network. A novel loss function is computed by employing the weighted softmax function (WSF) for enhancing minute MtS diagnosis and for calibrating susceptibility and particularity. The aim of this study was to merge temporal prior data for ABMS detection. The proffered VGG16_CNN is capable of differentiating positive MtS among MtS candidates with high confidence, which typically needs distinct specialist analysis or additional investigation, remaining specifically apt for specialist reinforcement in actual medical practice. The proffered VGG16_CNN framework can be correlated with three advanced methodologies (moU-Net, DSNet, and U-Net) concerning diverse criteria. It was observed that the proffered VGG16_CNN attained 93.74% accuracy, 92% precision, 92.1% recall, and 67.08% F1-score.
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Affiliation(s)
- Abdulaziz Alshammari
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia
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Avila J, Leone JP. Advances in the Management of Central Nervous System Metastases from Breast Cancer. Int J Mol Sci 2022; 23:12525. [PMID: 36293379 PMCID: PMC9604332 DOI: 10.3390/ijms232012525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022] Open
Abstract
Central nervous system (CNS) metastases are common in breast cancer (BC) patients and are particularly relevant as new treatments for BC are prolonging survival. Here, we review advances in the treatment of CNS metastases from BC, including radiotherapy, systemic therapies, and the evolving role of immunotherapy. The use of radiotherapy and chemotherapy is the cornerstone of treatment for CNS metastases. However, new targeted therapies have recently been developed, including anti-HER2 agents and antibody-drug conjugates that have presented promising results for the treatment of these patients.
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Affiliation(s)
- Jorge Avila
- Department of Internal Medicine, St Elizabeth’s Medical Center, 736 Cambridge St., Boston, MA 02135, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - José Pablo Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA 02215, USA
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Warren LEG, Niman SM, Remolano MC, Landry JM, Nakhlis F, Bellon JR, Aizer AA, Lin NU, Tolaney SM, Regan MM, Overmoyer BA, Lynce F. Incidence, characteristics, and management of central nervous system metastases in patients with inflammatory breast cancer. Cancer 2022; 128:4085-4094. [PMID: 36210737 DOI: 10.1002/cncr.34441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/25/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with inflammatory breast cancer (IBC) have a high risk of central nervous system metastasis (mCNS). The purpose of this study was to quantify the incidence of and identify risk factors for mCNS in patients with IBC. METHODS The authors retrospectively reviewed patients diagnosed with IBC between 1997 and 2019. mCNS-free survival time was defined as the date from the diagnosis of IBC to the date of diagnosis of mCNS or the date of death, whichever occurred first. A competing risks hazard model was used to evaluate risk factors for mCNS. RESULTS A total of 531 patients were identified; 372 patients with stage III and 159 patients with de novo stage IV disease. During the study, there were a total of 124 patients who had mCNS. The 1-, 2-, and 5-year incidence of mCNS was 5%, 9%, and 18% in stage III patients (median follow-up: 5.6 years) and 17%, 30%, and 42% in stage IV patients (1.8 years). Multivariate analysis identified triple-negative tumor subtype as a significant risk factor for mCNS for stage III patients. For patients diagnosed with metastatic disease, visceral metastasis as first metastatic site, triple-negative subtype, and younger age at diagnosis of metastases were risk factors for mCNS. CONCLUSIONS Patients with IBC, particularly those with triple-negative IBC, visceral metastasis, and those at a younger age at diagnosis of metastatic disease, are at significant risk of developing mCNS. Further investigation into prevention of mCNS and whether early detection of mCNS is associated with improved IBC patient outcomes is warranted.
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Affiliation(s)
- Laura E G Warren
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.,Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Samuel M Niman
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie C Remolano
- Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jean M Landry
- Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Faina Nakhlis
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer R Bellon
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.,Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meredith M Regan
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Beth A Overmoyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Filipa Lynce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Inflammatory Breast Cancer Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Uto M, Torizuka D, Mizowaki T. Single isocenter stereotactic irradiation for multiple brain metastases: current situation and prospects. Jpn J Radiol 2022; 40:987-994. [PMID: 36057071 PMCID: PMC9529683 DOI: 10.1007/s11604-022-01333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 10/29/2022]
Abstract
The prognosis of patients with brain metastases has dramatically improved, and long-term tumor control and reduction of the risk of late toxicities, including neurocognitive dysfunction, are important for patient quality of life. Stereotactic irradiation for multiple brain metastases, rather than whole-brain radiotherapy, can result in high local control rate with low incidence of neurocognitive deterioration and leukoencephalopathy. Recent advances in radiotherapy devices, treatment-planning systems, and image-guided radiotherapy can realize single isocenter stereotactic irradiation for multiple brain metastases (SI-STI-MBM), in which only one isocenter is sufficient to treat multiple brain metastases simultaneously. SI-STI-MBM has expanded the indications for linear accelerator-based stereotactic irradiation and considerably reduced patient burden. This review summarizes the background, methods, clinical outcomes, and specific consideration points of SI-STI-MBM. In addition, the prospects of SI-STI-MBM are addressed.
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Affiliation(s)
- Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daichi Torizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Wang T, Chen J, Yang J, Fu M, Hua W, Jia W, Liu Y, Wang B, Yan M, Zhou J, Hao C, Chen J, Ou D, Jiang T, Mao Y, Jiang Z. CSCO expert consensus on the diagnosis and treatment of breast cancer brain metastasis. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2022; 3:22. [PMID: 38751521 PMCID: PMC11092996 DOI: 10.21037/tbcr-22-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 05/18/2024]
Abstract
Breast cancer is one of the most common malignancies among women worldwide. According to the International Agency for Research on Cancer, breast cancer affected more Chinese women than any other cancer in 2020. The brain is an increasingly common metastatic sites of breast cancer. Although the risk of developing brain metastases (BMs) is lower in breast cancer than in lung cancer and melanoma, due to its high prevalence, it is the second most common cause of BM among solid tumors, being second only to lung cancer. The incidence of breast cancer brain metastasis (BCBM) differs by molecular subtype. Half of patients with advanced human epidermal growth factor receptor-2 (HER2)-positive and one-third of patients with triple-negative breast cancer (TNBC) develop BM. The clinical manifestations of leptomeningeal metastasis (LM) are often non-specific and may manifest as a variety of signs and symptoms, mainly including brain parenchyma involvement and meningeal irritation syndromes cranial nerve involvement, increased intracranial pressure, and progressive brain dysfunction. Therefore, the Chinese Society of Clinical Oncology (CSCO) Breast Cancer Committee has developed this expert consensus on BM, in an effort to improve the overall prognosis of BCBM and promote the standardized diagnosis and treatment of this disease. During the development of this expert consensus, we carried out a comprehensive literature review and referred to some of the most authoritative guidelines in China and abroad. In this consensus, we will discuss clinical manifestations, imaging examinations, pathological diagnosis, treatments, prognosis, follow-up and monitoring. We hope this consensus will be of help to all the clinicians majored in breast cancer and other similar professions.
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Affiliation(s)
- Tao Wang
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jiayi Chen
- Department of Radiotherapy, Ruijin Affiliated Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jin Yang
- Department of Oncology, The First Affiliated Hospital of Xi‘an Jiaotong University, Xi’an, China
| | - Minjie Fu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wang Jia
- Department of Neurosurgery, Tiantan Hospital, Beijing, China
| | - Yueping Liu
- Department of Pathology, Fourth Hospital Affiliated of Hebei Medical University, Shijiazhuang, China
| | - Biyun Wang
- Department of Oncology, Cancer Hospital Affiliated to Fudan University, ShanghaiChina
| | - Min Yan
- Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Juan Zhou
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Chunfang Hao
- Department of Oncology, Tumor Hospital of Tianjin, Tianjin, China
| | - Jiaxin Chen
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Dan Ou
- Department of Radiotherapy, Ruijin Affiliated Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Jiang
- Department of Neurosurgery, Tiantan Hospital, Beijing, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zefei Jiang
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - the CSCO expert panel of breast cancer*TengYueeZhangQingyuanLiManJinFengJiangZefeiWangTaoWenJuyiHaoChunfangGengCuizhiLiuYunjiangLiuYuepingZhangJunYanMinWanHaiboYuZhigangYinYongmeiPanYueyinChenJiayiWangBiyunWangXiaojiaOuyangQuchangLiuJiaLiuShuLiuQiangWangKunWangShusenNieJianyunLiHongyuanLiuXinlanSunGangXueYanYangJin
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Department of Radiotherapy, Ruijin Affiliated Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Oncology, The First Affiliated Hospital of Xi‘an Jiaotong University, Xi’an, China
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Neurosurgery, Tiantan Hospital, Beijing, China
- Department of Pathology, Fourth Hospital Affiliated of Hebei Medical University, Shijiazhuang, China
- Department of Oncology, Cancer Hospital Affiliated to Fudan University, ShanghaiChina
- Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
- Department of Oncology, Tumor Hospital of Tianjin, Tianjin, China
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Huang Y, Bert C, Sommer P, Frey B, Gaipl U, Distel LV, Weissmann T, Uder M, Schmidt MA, Dörfler A, Maier A, Fietkau R, Putz F. Deep learning for brain metastasis detection and segmentation in longitudinal MRI data. Med Phys 2022; 49:5773-5786. [PMID: 35833351 DOI: 10.1002/mp.15863] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Brain metastases occur frequently in patients with metastatic cancer. Early and accurate detection of brain metastases is essential for treatment planning and prognosis in radiation therapy. Due to their tiny sizes and relatively low contrast, small brain metastases are very difficult to detect manually. With the recent development of deep learning technologies, several researchers have reported promising results in automated brain metastasis detection. However, the detection sensitivity is still not high enough for tiny brain metastases, and integration into clinical practice in regard to differentiating true metastases from false positives is challenging. METHODS The DeepMedic network with the binary cross-entropy (BCE) loss is used as our baseline method. To improve brain metastasis detection performance, a custom detection loss called volume-level sensitivity-specificity (VSS) is proposed, which rates metastasis detection sensitivity and specificity at a (sub-)volume level. As sensitivity and precision are always a trade-off, either a high sensitivity or a high precision can be achieved for brain metastasis detection by adjusting the weights in the VSS loss without decline in dice score coefficient for segmented metastases. To reduce metastasis-like structures being detected as false positive metastases, a temporal prior volume is proposed as an additional input of DeepMedic. The modified network is called DeepMedic+ for distinction. Combining a high sensitivity VSS loss and a high specificity loss for DeepMedic+, the majority of true positive metastases are confirmed with high specificity, while additional metastases candidates in each patient are marked with high sensitivity for detailed expert evaluation. RESULTS Our proposed VSS loss improves the sensitivity of brain metastasis detection, increasing the sensitivity from 85.3% for DeepMedic with BCE to 97.5% for DeepMedic with VSS. Alternatively, the precision is improved from 69.1% for DeepMedic with BCE to 98.7% for DeepMedic with VSS. Comparing DeepMedic+ with DeepMedic with the same VSS loss, 44.4% of the false positive metastases are reduced in the high sensitivity model and the precision reaches 99.6% for the high specificity model. The mean dice coefficient for all metastases is about 0.81. With the ensemble of the high sensitivity and high specificity models, on average only 1.5 false positive metastases per patient need further check, while the majority of true positive metastases are confirmed. CONCLUSIONS Our proposed VSS loss and temporal prior improve brain metastasis detection sensitivity and precision. The ensemble learning is able to distinguish high confidence true positive metastases from metastases candidates that require special expert review or further follow-up, being particularly well-fit to the requirements of expert support in real clinical practice. This facilitates metastasis detection and segmentation for neuroradiologists in diagnostic and radiation oncologists in therapeutic clinical applications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yixing Huang
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Philipp Sommer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Udo Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Luitpold V Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Thomas Weissmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Universitätsklinikum Erlangen, FAU, Erlangen, Germany
| | - Manuel A Schmidt
- Department of Neuroradiology, Universitätsklinikum Erlangen, FAU, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Universitätsklinikum Erlangen, FAU, Erlangen, Germany
| | | | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Local and systemic therapy in breast cancer patients with central nervous system metastases. Breast Cancer Res Treat 2022; 194:365-384. [PMID: 35680734 DOI: 10.1007/s10549-022-06605-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE As survival of patients with central nervous system (CNS) metastases from breast cancer is poor and incidence rates are increasing, there is a growing need for better treatment strategies. In the current study, the efficacy of local and systemic therapies was analyzed in breast cancer patients with CNS metastases. METHODS Medical records from breast cancer patients with brain and/or leptomeningeal metastases (LM) treated at a tertiary referral center and a teaching hospital between 2010 and 2020 were retrospectively studied. Main outcomes of interest were overall survival (OS) and CNS progression free survival. Analyses were performed among patients with brain metastases (BM) and patients with LM, for the different systemic and local therapies for CNS metastases, and for subgroups based on breast cancer subtypes. RESULTS We identified 155 patients, 97 with BM and 58 with LM. Median OS was 15.9 months for patients with BM and 1.5 months for patients with LM. Median OS was significantly longer for HER2-positive patients with BM (22.8 months) vs triple negative (8.4 months) and hormone receptor positive/HER2-negative (5.9 months) (P < 0.001). Patients with BM receiving both local and systemic therapy also had a longer median OS (21.8 months), compared to the other three subgroups (local therapy only: 9.9 months, systemic therapy only: 4.3 months, no therapy: 0.5 months, P < 0.001). No significant difference in OS was observed between different systemic treatment regimens. CONCLUSION Breast cancer patients with BM show longest median OS when the subtype is HER2-positive and when they are treated with both local and systemic therapy.
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Konopka-Filippow M, Hempel D, Sierko E. Actual, Personalized Approaches to Preserve Cognitive Functions in Brain Metastases Breast Cancer Patients. Cancers (Basel) 2022; 14:cancers14133119. [PMID: 35804894 PMCID: PMC9265102 DOI: 10.3390/cancers14133119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Breast cancer is the one of most common causes of brain metastases among solid malignancies, being responsible for 10–16% of all brain metastases in oncological patients. Brain metastases in the course of breast cancer significantly worsen quality of life of patients, especially in the aspect of neurocognitive domains. The review aims to summarize and integrate the current knowledge about breast cancer brain metastases, focusing on indications of certain types of treatment, and with special attention to the role of hippocampus sparing in preserving neurocognitive functions in irradiated patients. Abstract Breast cancer (BC) is the most often diagnosed cancer among women worldwide and second most common cause of brain metastases (BMs) among solid malignancies being responsible for 10–16% of all BMs in oncological patients. Moreover, BMs are associated with worse prognosis than systemic metastases. The quality of life (QoL) among brain metastases breast cancer (BMBC) patients is significantly influenced by cognitive functions. Cancer-related cognitive deficits and the underlying neural deficits in BMBC patients can be caused via BMs per se, chemotherapy administration, brain irradiation, postmenopausal status, or comorbidities. Brain RT often leads to cognitive function impairment by damage of neural progenitor cells of the hippocampus and hence decreased QoL. Sparing the hippocampal region of the brain during RT provides protective covering of the centrally located hippocampi according to the patient’s clinical requirements. This article discusses the personalized strategies for treatment options to protect cognitive functions in BMBC patients, with special emphasis on the innovative techniques of radiation therapy.
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Affiliation(s)
- Monika Konopka-Filippow
- Department of Oncology, Medical University of Bialystok, 15-274 Bialystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Bialystok, Poland
| | - Dominika Hempel
- Department of Oncology, Medical University of Bialystok, 15-274 Bialystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Bialystok, Poland
| | - Ewa Sierko
- Department of Oncology, Medical University of Bialystok, 15-274 Bialystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-85-664-6734; Fax: +48-66-46-783
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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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Id Said B, Chen H, Jerzak KJ, Warner E, Myrehaug S, Tseng CL, Detsky J, Husain Z, Sahgal A, Soliman H. Trastuzumab emtansine increases the risk of stereotactic radiosurgery-induced radionecrosis in HER2 + breast cancer. J Neurooncol 2022; 159:177-183. [PMID: 35715667 DOI: 10.1007/s11060-022-04055-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In this study, we investigate factors associated with radionecrosis (RN) in HER2 + (human epidermal growth factor receptor 2) patients with brain metastases (BrM) treated with stereotactic radiosurgery (SRS). METHODS Patients with HER2 + breast cancer BrM treated with SRS (2010-2020) were identified from an institutional database. The incidence of RN was determined per treated BrM according to serial imaging and/or histology. Factors associated with RN such as age, RT dose, BrM volume, and initiation of Trastuzumab Emtansine (T-DM1) were investigated with univariate and multivariable analyses (MVA). RESULTS 67 HER2 + patients with 223 BrM were identified. 21 patients (31.3%) were treated with T-DM1 post-SRS, including 14 patients (20.9%) who received T-DM1 within 12 months of SRS. The median follow-up was 15.6 (interquartile range (IQR) 5.4-35.3) months. The overall probability of RN post-SRS was 21.6% (95% confidence interval (CI) 2.7-10.7), and the 1 and 2 year risk was 6.7% (95% CI 2.7-10.7) and 15.2% (95% CI 9.2-21.3). MVA identified T-DM1 treatment post-SRS (hazard ratio (HR) 2.5, 95% CI 1.2-5.3, p = 0.02) and equivalent dose in 2 Gy fractions (EQD2) > 90 Gy2 (HR 2.4, 95% CI 1.1-5.1, p = 0.02) as predictors of RN. Patients treated with T-DM1 and SRS had a 29.9% (95% CI 15.3-44.6%) probability of RN, with a 25.2% (95% CI 12.8-37.6%) risk at 1- and 2 years post-T-DM1. The majority of RN were symptomatic (71%), with a median time to RN of 4.8 months. CONCLUSION T-DM1 exposure post-SRS was associated with a higher risk of RN among patients with HER2 + BrM.
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Affiliation(s)
- Badr Id Said
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Katarzyna J Jerzak
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Ellen Warner
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, 2075 Bayview Ave., T2 181, Toronto, ON, M4N 3M5, Canada.
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Michel A, Dinger TF, Santos AN, Pierscianek D, Darkwah Oppong M, Ahmadipour Y, Dammann P, Wrede KH, Hense J, Pöttgen C, Iannaccone A, Kimmig R, Sure U, Jabbarli R. Time interval between the diagnosis of breast cancer and brain metastases impacts prognosis after metastasis surgery. J Neurooncol 2022; 159:53-63. [PMID: 35672530 PMCID: PMC9325855 DOI: 10.1007/s11060-022-04043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/21/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose
Breast cancer (BC) is the most frequently diagnosed tumor entity in women. Occurring at different time intervals (TI) after BC diagnosis, brain metastases (BM) are associated with poor prognosis. We aimed to identify the risk factors related to and the clinical impact of timing on overall survival (OS) after BM surgery.
Methods
We included 93 female patients who underwent BC BM surgery in our institution (2008–2019). Various clinical, radiographic, and histopathologic markers were analyzed with respect to TI and OS.
Results
The median TI was 45.0 months (range: 9–334.0 months). Fifteen individuals (16.1%) showed late occurrence of BM (TI ≥ 10 years), which was independently related to invasive lobular BC [adjusted odds ratio (aOR) 9.49, 95% confidence interval (CI) 1.47–61.39, p = 0.018] and adjuvant breast radiation (aOR 0.12, 95% CI 0.02–0.67, p = 0.016). Shorter TI (< 5 years, aOR 4.28, 95% CI 1.46–12.53, p = 0.008) was independently associated with postoperative survival and independently associated with the Union for International Cancer Control stage (UICC) III–IV of BC (aOR 4.82, 95% CI 1.10–21.17, p = 0.037), midline brain shift in preoperative imaging (aOR10.35, 95% CI 1.09–98.33, p = 0.042) and identic estrogen receptor status in BM (aOR 4.56, 95% CI 1.35–15.40, p = 0.015).
Conclusions
Several factors seem to influence the period between BC and BM. Occurrence of BM within five years is independently associated with poorer prognosis after BM surgery. Patients with invasive lobular BC and without adjuvant breast radiation are more likely to develop BM after a long progression-free survival necessitating more prolonged cancer aftercare of these individuals.
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Affiliation(s)
- Anna Michel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany.
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany.
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Alejandro N Santos
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Rainer Kimmig
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
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Ramakrishna N, Anders CK, Lin NU, Morikawa A, Temin S, Chandarlapaty S, Crews JR, Davidson NE, Franzoi MAB, Kirshner JJ, Krop IE, Patt DA, Perlmutter J, Giordano SH. Management of Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases: ASCO Guideline Update. J Clin Oncol 2022; 40:2636-2655. [PMID: 35640075 DOI: 10.1200/jco.22.00520] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To provide updated evidence- and consensus-based guideline recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer up to 2021. METHODS An Expert Panel conducted a targeted systematic literature review (for both systemic therapy for non-CNS metastases and for CNS metastases of HER2+ guideline updates) that identified 545 articles. Outcomes of interest included overall survival, progression-free survival, and adverse events. RESULTS Of the 545 publications identified and reviewed, six on systemic therapy were identified to form the evidentiary basis for the systemic therapy for CNS metastases guideline recommendations. RECOMMENDATIONS Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Memantine and hippocampal avoidance should be added to whole-brain radiotherapy when possible. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. There are insufficient data to recommend for or against performing routine magnetic resonance imaging to screen for brain metastases; clinicians should have a low threshold for magnetic resonance imaging of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer.Additional information is available at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | | | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
| | | | | | - Ian E Krop
- Dana-Farber Cancer Institute, Boston, MA
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47
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Katano A, Yamashita H. Brain metastasis: Recent treatment modalities and future‑perspectives (Review). Oncol Lett 2022; 23:191. [DOI: 10.3892/ol.2022.13311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Atsuto Katano
- Department of Radiology, University of Tokyo Hospital, Bunkyo, Tokyo 113‑8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Bunkyo, Tokyo 113‑8655, Japan
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48
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Puri A, Mylavarapu C, Xu J, Patel TA, S Teh B, Tremont-Lukats I, Chang JC, Niravath P. Clinical factors and association with treatment modalities in patients with breast cancer and brain metastases who develop leptomeningeal metastases. Breast Cancer Res Treat 2022; 193:613-623. [PMID: 35460498 DOI: 10.1007/s10549-022-06595-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/01/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Leptomeningeal metastases (LM) are an aggressive complication of metastatic breast cancer (MBC) with brain metastases (BM), with a short survival of weeks to months. Studies suggest that surgical resection of BM may increase the risk of LM, especially in infratentorial metastases. In this retrospective study, we examine this and other factors which may be associated with increased risk of LM. METHODS A database search at a single institution identified 178 patients with MBC and treated BM between 2007 and 2020. We collected demographic, clinical, radiographic, and other treatment data. LM was diagnosed by cerebrospinal fluid (CSF) cytology, neuroimaging, or both. Cox proportional hazards model was used. RESULTS After a median follow-up of 8.5 months, 41 out of 178 patients (23%) with BM developed LM. Median time to develop LM was 130 days. Mean age was 51.3 years. The number and size of the BM, hemorrhagic/cystic lesions, progressive/stable systemic disease, and extracranial metastases sites other than liver did not pose a higher risk of LM. Infratentorial lesions (HR = 5.41) and liver metastases (HR = 2.28) had a higher risk of LM. Patients who had any surgery did not have a higher risk for LM (HR 1.13). The LM group had a worse overall survival as compared to the non-LM group. CONCLUSION Among MBC patients with BM, infratentorial BM and visceral liver lesions increase the risk of LM, whereas local treatment modalities such as surgery and radiation do not. These data imply that local treatment strategy should not differ based on potential risk for LM.
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Affiliation(s)
- Akshjot Puri
- Clinical Fellow, Hematology/Oncology, Houston Methodist Cancer Center, 6445 Main St, Houston, TX, 77030, USA.
| | - Charisma Mylavarapu
- Resident, Internal Medicine, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, 77030, USA
| | - Jiaqiong Xu
- Center for Outcomes Research, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Research Institute, 6445 Main St, Houston, TX, 77030, USA
| | - Tejal A Patel
- Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, 77030, USA
| | - Ivo Tremont-Lukats
- Department of Neuro Oncology, Houston Methodist Cancer Center, 6445 Main St, Houston, TX, 77030, USA
| | - Jenny C Chang
- Breast Medical Oncology, Chair & Director Cancer Center, Houston Methodist Cancer Center, 6445 Main St, Houston, TX, 77030, USA
| | - Polly Niravath
- Breast Medical Oncology Faculty, Houston Methodist Cancer Center, 6445 Main St, Houston, TX, 77030, USA
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p16 INK4A-deficiency predicts response to combined HER2 and CDK4/6 inhibition in HER2+ breast cancer brain metastases. Nat Commun 2022; 13:1473. [PMID: 35304445 PMCID: PMC8933392 DOI: 10.1038/s41467-022-29081-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/22/2022] [Indexed: 12/20/2022] Open
Abstract
Approximately 50% of patients with metastatic HER2-positive (HER2+) breast cancer develop brain metastases (BCBMs). We report that the tumor suppressor p16INK4A is deficient in the majority of HER2+ BCBMs. p16INK4A-deficiency as measured by protein immunohistochemistry predicted response to combined tucatinib and abemaciclib in orthotopic patient-derived xenografts (PDXs) of HER2 + BCBMs. Our findings establish the rationale for a biomarker-driven clinical trial of combined CDK4/6- and HER2-targeted agents for patients with HER2 + BCBM.
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50
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Michel A, Darkwah Oppong M, Rauschenbach L, Dinger TF, Barthel L, Pierscianek D, Wrede KH, Hense J, Pöttgen C, Junker A, Schmidt T, Iannaccone A, Kimmig R, Sure U, Jabbarli R. Prediction of Short and Long Survival after Surgery for Breast Cancer Brain Metastases. Cancers (Basel) 2022; 14:cancers14061437. [PMID: 35326590 PMCID: PMC8946189 DOI: 10.3390/cancers14061437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 12/09/2022] Open
Abstract
Background: Brain metastases requiring surgical treatment determine the prognosis of patients with breast cancer. We aimed to develop the scores for the prediction of short (<6 months) and long (≥3 years) survival after BCBM surgery. Methods: Female patients with BCBM surgery between 2008 and 2019 were included. The new scores were constructed upon independent predictors for short and long postoperative survival. Results: In the final cohort (n = 95), 18 (18.9%) and 22 (23.2%) patients experienced short and long postoperative survival, respectively. Breast-preserving surgery, presence of multiple brain metastases and age ≥ 65 years at breast cancer diagnosis were identified as independent predictors of short postoperative survival. In turn, positive HER2 receptor status in brain metastases, time interval ≥ 3 years between breast cancer and brain metastases diagnosis and KPS ≥ 90% independently predicted long survival. The appropriate short and long survival scores showed higher diagnostic accuracy for the prediction of short (AUC = 0.773) and long (AUC = 0.775) survival than the breast Graded Prognostic Assessment score (AUC = 0.498/0.615). A cumulative survival score (total score) showed significant association with overall survival (p = 0.001). Conclusion: We identified predictors independently impacting the prognosis after BCBM surgery. After external validation, the presented scores might become useful tools for the selection of proper candidates for BCBM surgery.
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Affiliation(s)
- Anna Michel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
- Correspondence: ; Tel.: +49-201-723-1230; Fax: +49-201-723-1220
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Lennart Barthel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Jörg Hense
- Department of Medical Oncology, University Hospital Essen, 45147 Essen, Germany;
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital Essen, 45147 Essen, Germany;
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, 45147 Essen, Germany;
| | - Teresa Schmidt
- Department of Neurooncology, University Hospital Essen, 45147 Essen, Germany;
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, 45147 Essen, Germany; (A.I.); (R.K.)
| | - Rainer Kimmig
- Department of Obstetrics and Gynecology, University Hospital Essen, 45147 Essen, Germany; (A.I.); (R.K.)
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
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