The evolving role of trastuzumab emtansine (T-DM1) in HER2-positive breast cancer with brain metastases

2019 ◽  
Vol 143 ◽  
pp. 20-26 ◽  
Author(s):  
Rongrong Dong ◽  
Jiali Ji ◽  
Hong Liu ◽  
Xuexin He
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Trastuzumab Emtansine ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

scholarly journals Current approaches to the treatment of HER2‑positive breast cancer with brain metastases

2021 ◽  
Vol 17 (1) ◽  
pp. 27-34
Author(s):  
T.  Yu. Semiglazova ◽  
S.  M. Sharashenidze ◽  
S.  N. Kerimova ◽  
V.   V. Klimenko ◽  
A. Yu. Malygin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Antitumor Activity ◽  
Brain Metastases ◽  
Local Treatment ◽  
Drug Distribution ◽  
Trastuzumab Emtansine ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Clinically Significant ◽  
Positive Breast Cancer

The article discusses modern approaches in the treatment of HER2-positive breast cancer (BC) with brain metastases (BM).The patients are subject to multidisciplinary, comprehensive and biologically – oriented treatment, with the involvement of a neurosurgeon and a radiation therapist to make a decision considering local treatment of BM, as well as a clinical oncologist to choose systemic drug therapy. Local treatment of HER2+ BC with BM patients includes surgical treatment and/or radiotherapy. Use of targeted anti-HER2 therapy changes “biology” of the disease from aggressive to indolent.In the prospective KAMILLA trial, clinically significant antitumor activity of trastuzumab emtansine was found for the first time both in patients with HER2+ BC with BM, who were previously treated with radiotherapy, and without radiotherapy in the anamnesis, which suggests the validity of further use of trastuzumab emtansine in this category of patients.The antitumor activity of trastuzumab emtansine in patients with HER2+ BC with BM was also confirmed in preclinical models. Despite the similar drug distribution in the tissues, trastuzumab emtansine, in contrast to trastuzumab, significantly slowed the growth of metastases, causing the induction of apoptosis in HER2+ BC models with BM in mice.

Efficacy and safety of trastuzumab emtansine (T-DM1) in patients with HER2-positive breast cancer with brain metastases

2016 ◽  
Vol 157 (2) ◽  
pp. 307-318 ◽  
Author(s):  
William Jacot ◽  
Elvire Pons ◽  
Jean-Sébastien Frenel ◽  
Séverine Guiu ◽  
Christelle Levy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Trastuzumab Emtansine ◽  
Efficacy And Safety ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

Brain metastases in HER2-positive breast cancer: The evolving role of lapatinib

2010 ◽  
Vol 75 (2) ◽  
pp. 110-121 ◽  
Author(s):  
Gianluca Tomasello ◽  
Philippe L. Bedard ◽  
Evandro de Azambuja ◽  
Dominique Lossignol ◽  
Daniel Devriendt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

scholarly journals Trastuzumab Emtansine (T-DM1) and stereotactic radiation in the management of HER2+ breast cancer brain metastases

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew N. Mills ◽  
Chelsea Walker ◽  
Chetna Thawani ◽  
Afrin Naz ◽  
Nicholas B. Figura ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Trastuzumab Emtansine ◽  
Median Dose ◽  
Her2 Positive ◽  
Stereotactic Radiation ◽  
Her2 Positive Breast Cancer ◽  
Breast Cancer Brain Metastases ◽  
Positive Breast Cancer

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

scholarly journals 34. TARGETED THERAPY FOR HER2-POSITIVE BREAST CANCER BRAIN METASTASES: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 2 (Supplement_2) ◽  
pp. ii6-ii6
Author(s):  
Anders Erickson ◽  
Farinaz Ghodrati ◽  
Sunit Das
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Targeted Therapy ◽  
Brain Metastases ◽  
Meta Analysis ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Meta Analyses ◽  
Positive Breast Cancer

Abstract INTRO One in three women with HER2-positive breast cancer will develop brain metastases, or intracranial metastatic disease (IMD). Historically, treatment of IMD has been confined to surgery and radiotherapy, with a limited role for chemotherapy. However, recent interest has burgeoned in a role for targeted therapy for treatment of IMD. The lack of high-level evidence, such as meta-analyses, regarding the role of targeted therapy in the management of IMD has prevented its inclusion in guidelines directing treatment. We performed a systematic review and meta-analysis to clarify the role of targeted therapy for IMD in women with HER2-positive breast cancer. METHODS Following PRISMA guidelines, a search of MEDLINE, CENTRAL, EMBASE, Google Scholar, and grey literature sources was conducted by two independent reviewers. Controlled trials and cohort studies that reported survival, safety, or response outcomes for patients receiving HER2-targeted therapy following IMD diagnosis were included. Meta-analyses using a random-effects model were conducted for OS and PFS. RESULTS 111 studies reporting on 8226 patients were included. Primary analysis of only RCTs found that HER2-targeted therapy was associated with improved OS (HR 0.63; 95% CI, 0.46–0.86; n = 392) but not PFS (HR 0.75; 95% CI, 0.30–1.85; n = 392) following IMD diagnosis. Secondary analysis combining RCTs and comparative observational studies found that HER2-targeted therapy was associated with improved OS (HR 0.42; 95% CI, 0.35–0.51; n = 2756) but not PFS (HR 0.58; 95% CI, 0.27–1.21; n = 460) following IMD diagnosis. Full analysis will be conducted for all 111 studies for pre-specified outcomes including intracranial PFS. CONCLUSION These findings support a potential role for HER2-targeted therapy in the management of IMD from HER2-positive breast cancer. Final analysis will synthesize current evidence for outcomes of intracranial response, survival, and safety.

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