Title |
Trastuzumab Emtansine (T-DM1) and stereotactic radiation in the management of HER2+ breast cancer brain metastases
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Published in |
BMC Cancer, March 2021
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DOI | 10.1186/s12885-021-07971-w |
Pubmed ID | |
Authors |
Matthew N. Mills, Chelsea Walker, Chetna Thawani, Afrin Naz, Nicholas B. Figura, Sergiy Kushchayev, Arnold Etame, Hsiang-Hsuan Michael Yu, Timothy J. Robinson, James Liu, Michael A. Vogelbaum, Peter A. Forsyth, Brian J. Czerniecki, Hatem H. Soliman, Hyo S. Han, Kamran A. Ahmed |
Abstract |
Due to recent concerns about the toxicity of trastuzumab emtansine (T-DM1) with stereotactic radiation, we assessed our institutional outcomes treating HER2-positive breast cancer brain metastases (BCBM) with T-DM1 and stereotactic radiation. This is a single institution series of 16 patients with HER2-positive breast cancer who underwent 18 stereotactic sessions to 40 BCBM from 2013 to 2019 with T-DM1 delivered within 6 months. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), distant intracranial control (DIC), and systemic progression-free survival (sPFS) from the date of SRS. A neuro-radiologist independently reviewed follow-up imaging. One patient had invasive lobular carcinoma, and 15 patients had invasive ductal carcinoma. All cases were HER2-positive, while 10 were hormone receptor (HR) positive. Twenty-four lesions were treated with stereotactic radiosurgery (SRS) to a median dose of 21 Gy (14-24 Gy). Sixteen lesions were treated with fractionated stereotactic radiation (FSRT) with a median dose of 25 Gy (20-30Gy) delivered in 3 to 5 fractions. Stereotactic radiation was delivered concurrently with T-DM1 in 19 lesions (48%). Median follow up time was 13.2 months from stereotactic radiation. The 1-year LC, DIC, sPFS, and OS were 75, 50, 30, and 67%, respectively. There was 1 case of leptomeningeal progression and 1 case (3%) of symptomatic radionecrosis. We demonstrate that stereotactic radiation and T-DM1 is well-tolerated and effective for patients with HER2-positive BCBM. An increased risk for symptomatic radiation necrosis was not noted in our series. |
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Members of the public | 1 | 100% |
Mendeley readers
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Unknown | 48 | 100% |
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Researcher | 6 | 13% |
Student > Bachelor | 5 | 10% |
Student > Postgraduate | 3 | 6% |
Student > Master | 3 | 6% |
Student > Ph. D. Student | 2 | 4% |
Other | 3 | 6% |
Unknown | 26 | 54% |
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Medicine and Dentistry | 15 | 31% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 2% |
Biochemistry, Genetics and Molecular Biology | 1 | 2% |
Immunology and Microbiology | 1 | 2% |
Mathematics | 1 | 2% |
Other | 2 | 4% |
Unknown | 27 | 56% |