scholarly journals RADI-18. Survival and disease control after upfront stereotactic radiosurgery for brain metastases from breast cancer

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii21-iii22
Author(s):  
Yan Wang ◽  
Ran An ◽  
Fuchenchu Wang ◽  
Chao Gao ◽  
Akshara Singareeka Raghavendra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Hormone Therapy ◽  
Stereotactic Radiosurgery ◽  
Systemic Therapy ◽  
Molecular Subtypes ◽  
Treatment Strategies ◽  
Metastatic Breast ◽  
Factors Associated ◽  
Cox Proportional Hazard Regression

Abstract Background As systemic therapy for metastatic breast cancer (BC) improves, the survival benefit from hormonal and targeted therapy urges treatment of brain metastases (BMs) with minimal toxicity and less systemic therapy interruption. Here we assessed clinical outcomes in BC patients who received upfront stereotactic radiosurgery (SRS). Methods We identified 236 patients who received upfront SRS with/without surgery for BMs from metastatic BC from 06/2007 to 05/2018. Twenty-four patients who received SRS for surgical cavity were excluded for analysis. Overall survival (OS) and salvage radiation-free survival (SRFS) were estimated using Kaplan-Meier analysis. Cox proportional hazard regression was used to identify prognostic factors. Results At a median follow-up time of 15.4 months (range, 0.8–119.6), the estimated median OS was 18.5 mo (95% CI, 14.9–21). Factors associated with OS on multivariate analysis (MVA) were molecular subtypes (12.2 months for triple-negative [n=68], 13.3 months for HR+/HER2- [n=66], 36.4 months for HR+/HER2+ [n=46], and 28.1 months for HER2+ [n=32], p=0.002), KPS >80 (p<0.0001), receipt of chemotherapy (p=0.016) or anti-HER2 therapy (p=0.029) after diagnosis of BM, and type of salvage radiation (p<0.0001). OS was comparable in patients who received upfront SRS to less or more than 4 lesions (19.3 months for <4 [n=162] vs. 17.8 months for >/= 4 [n=50], p=0.36). The 12-month salvage RT rate was 25% for WBRT and 26.4% for SRS. The median SRFS was 7.4 months (95% CI, 6.5‒8.3). Factors associated with SRFS on MVA were subtypes (p=0.002), KPS (p=0.011), and receipt of hormone therapy after diagnosis of BM (p=0.031). Conclusions The median OS for BC patients who developed BM is over 15 months. Molecular subtypes (HER2+ and HR+/HER2+), good KPS, and anti-HER2 or hormone therapy predicted better OS and SRFS. Prospective studies are needed to verify these results and refine the best treatment strategies for these patients.

Survival and disease control after upfront stereotactic radiosurgery for brain metastases from breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14013-e14013
Author(s):  
Yan Wang ◽  
Ran An ◽  
Fuchenchu Wang ◽  
Akshara Singareeka Raghavendra ◽  
Chao Gao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Disease Control ◽  
Hormone Therapy ◽  
Stereotactic Radiosurgery ◽  
Molecular Subtypes ◽  
Central Nervous System Involvement ◽  
Metastatic Breast ◽  
Karnofsky Performance Score ◽  
Factors Associated

e14013 Background: As systemic therapy for metastatic breast cancer (BC) improves, effective treatment for central nervous system involvement has become a major concern, as 10%‒30% of such patients develop brain metastases (BMs). The survival benefit from hormonal and targeted therapy urges to treat patients with BMs with minimal toxicity and less systemic interruption. Here we assessed survival and disease control in patients who received upfront stereotactic radiosurgery (SRS). Methods: We retrospectively reviewed 236 patients who received upfront SRS with/without surgery for BMs from metastatic BC at a single large-volume cancer center from June 2007 to May 2018. We excluded patients who received SRS for surgical cavity alone. A total of 212 were evaluable, of whom 68 had triple-negative (TN), 66 HR+/HER2-, 46 HR+/HER2+, and 32 HER2+ molecular subtypes. Primary endpoints were overall survival (OS) from BM diagnosis and salvage radiation free survival (SRTFS), which were estimated by Kaplan-Meier survival analysis. Cox proportional hazard regression analysis was used to identify prognostic factors. Results: Median age at BM diagnosis was 52.5 y (range 25.6‒85.4); median Karnofsky Performance Score (KPS) was 90 (range 60‒100); and median number of BMs treated was 2 (range 1‒17). At a median follow-up time of 15.4 months (mo) (range, 0.8–119.6), the estimated median OS was 18.5 mo (95% CI, 14.9–21). Factors associated with OS on multivariate analysis (MVA) were subtype (12.2 mo for TN, 13.3 mo for HR+/HER2-, 36.4 mo for HR+/HER2+, and 28.1 mo for HER2+, p= 0.002), KPS ( p <0.0001), receipt of chemotherapy ( p= 0.016) or anti HER2+ therapy (0.029) after diagnosis of BM, and type of salvage radiation ( p <0.0001). Age, extracranial disease status at BM diagnosis, or receipt of upfront surgery was not associated with OS. OS was also comparable in patients who received upfront SRS to less or more than 4 lesions (19.3 mo for < 4 [n = 162] vs. 17.8 mo for > / = 4 [n = 50], p= 0.36). Of the 106 patients (50%) who received salvage therapy after initial SRS, 42 received salvage SRS, 28 received salvage whole-brain radiation therapy (WBRT), and 36 received both. The 12-month salvage RT rate was 25% for WBRT and 26.4% for SRS. The median SRTFS was 7.4 mo (95% CI, 6.5‒8.3). Factors associated with SRTFS on MVA were subtype ( p= 0.002), KPS ( p= 0.011), and receipt of Hormone therapy after a diagnosis of BM (p = 0.031). Conclusions: Molecular subtypes of HER2+ and HR+/HER2+, good KPS, and receipt of chemotherapy or anti-HER2 therapy predicted better OS for patients who received upfront SRS for BMs from BC. Number of BMs treated by upfront SRS was not associated with OS. Molecular subtype, KPS, and receipt of Hormone therapy were also associated with SRTFS. Prospective studies are needed to clarify the best treatment strategies for the various subgroups of patients with BMs from BC particularly in the era of increasing use of new systemic therapies.

scholarly journals Hormone therapy for premenopausal women with metastatic breast cancer: combinations with cyclin-dependent kinase inhibitors

2019 ◽  
Vol 15 (2) ◽  
pp. 30-41
Author(s):  
E. V. Artamonova ◽  
E. I. Kovalenko
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Hormone Therapy ◽  
Randomized Trials ◽  
Kinase Inhibitors ◽  
Treatment Strategies ◽  
Metastatic Breast ◽  
Premenopausal Women ◽  
Cyclin Dependent Kinase ◽  
Ovarian Suppression

This article discusses the problems associated with the search of the most effective treatment strategies for HER2-negative metastatic breast cancer in premenopausal women. Until recently, ovarian suppression and hormone therapy had been the main treatments used in this group of patients. The development of palbociclib, called a “breakthrough therapy”, as well as promising results of trials evaluating the efficacy of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors added to hormone therapy in postmenopausal women suggested a need for the assessment of this treatment regimen in combination with ovarian suppression in younger patients.According to the results of randomized trials and subgroup analysis, the addition of a CDK4/6 inhibitor to ovarian suppression and hormonal therapy significantly increases survival. The safety profile is similar to that of older patients. Randomized trials comparing the efficacy of palbociclib + ovarian suppression + aromatase inhibitor vs. chemotherapy in premenopausal women demonstrated significant benefits of a new treatment strategy: a CDK4/6 inhibitor as a part of combination therapy reduced the risk of progression by 36 % compared to capecitabine.

Stereotactic radiosurgery as primary and salvage treatment for brain metastases from breast cancer

2011 ◽  
Vol 114 (3) ◽  
pp. 792-800 ◽  
Author(s):  
Douglas Kondziolka ◽  
Hideyuki Kano ◽  
Gillian L. Harrison ◽  
Huai-che Yang ◽  
Donald N. Liew ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Radiation Effects ◽  
Tumor Volume ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Factors Associated ◽  
Total Tumor Volume

Object To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from breast cancer, the authors assessed clinical outcomes and prognostic factors for survival. Methods The records from 350 consecutive female patients who underwent SRS for 1535 brain metastases from breast cancer were reviewed. The median patient age was 54 years (range 19–84 years), and the median number of tumors per patient was 2 (range 1–18 lesions). One hundred seventeen patients (33%) had a single metastasis to the brain, and 233 patients (67%) had multiple brain metastases. The median tumor volume was 0.7 cm3 (range 0.01–48.9 cm3), and the median total tumor volume for each patient was 4.9 cm3 (range 0.09–74.1 cm3). Results Overall survival after SRS was 69%, 49%, and 26% at 6, 12, and 24 months, respectively, with a median survival of 11.2 months. Factors associated with a longer survival included controlled extracranial disease, a lower recursive partitioning analysis (RPA) class, a higher Karnofsky Performance Scale score, a smaller number of brain metastases, a smaller total tumor volume per patient, the presence of deep cerebral or brainstem metastases, and HER2/neu overexpression. Sustained local tumor control was achieved in 90% of the patients. Factors associated with longer progression-free survival included a better RPA class, fewer brain metastases, a smaller total tumor volume per patient, and a higher tumor margin dose. Symptomatic adverse radiation effects occurred in 6% of patients. Overall, the condition of 82% of patients improved or remained neurologically stable. Conclusions Stereotactic radiosurgery was safe and effective in patients with brain metastases from breast cancer and should be considered for initial treatment.

Redrawing the Lines: The Next Generation of Treatment in Metastatic Breast Cancer

2019 ◽  
pp. e8-e21 ◽  
Author(s):  
Marie-France Savard ◽  
Omar Khan ◽  
Kelly K. Hunt ◽  
Sunil Verma
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Systemic Therapy ◽  
Mammalian Target Of Rapamycin ◽  
Treatment Strategies ◽  
Metastatic Breast ◽  
Careful Consideration ◽  
Locoregional Therapy ◽  
Immune Checkpoints ◽  
Novel Treatments

Although not considered curative in nature, new therapeutic advances in metastatic breast cancer (MBC) have substantially improved patient outcomes. This article discusses the state-of-the-art and emerging therapeutic options for management of MBC. BC systemic therapy targets multiple key pathways, including estrogen receptor signaling, HER2 signaling, and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling. Other therapeutic strategies include targeting DNA repair, inhibiting immune checkpoints, and developing antibody-drug conjugates. Although surgery historically was reserved for palliation of symptomatic, large, or ulcerating masses, some data suggest a possibly expanding role for more aggressive locoregional therapy in combination with systemic therapy. As technology develops, biomarker-specific, line-agnostic, and receptor-agnostic treatment strategies will redraw the current lines of MBC care. However, tumor heterogeneity remains a challenge. To effectively reshape our approach to MBC, careful consideration of the patient perspective, the costs and value of novel treatments, and accessibility (especially in developing countries) is paramount.

scholarly journals Brain Metastases in HER2-Positive Breast Cancer: Current and Novel Treatment Strategies

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2927
Author(s):  
Alejandro Garcia-Alvarez ◽  
Andri Papakonstantinou ◽  
Mafalda Oliveira
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Treatment Strategies ◽  
Metastatic Breast ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Novel Treatment ◽  
Increased Risk ◽  
Novel Treatment Strategies ◽  
Positive Breast Cancer

Development of brain metastases can occur in up to 30–50% of patients with breast cancer, representing a significant impact on an individual patient in terms of survival and quality of life. Patients with HER2-positive breast cancer have an increased risk of developing brain metastases; however, screening for brain metastases is not currently recommended due to the lack of robust evidence to support survival benefit. In recent years, several novel anti-HER2 agents have led to significant improvements in the outcomes of HER2-positive metastatic breast cancer. Despite these advances, brain and leptomeningeal metastases from HER2-positive breast cancer remain a significant cause of morbidity and mortality, and their optimal management remains an unmet need. This review presents an update on the current and novel treatment strategies for patients with brain metastases from HER2-positive breast cancer and discusses the open questions in the field.

LINAC-based stereotactic radiosurgery/radiotherapy for brain metastases in patients with breast cancer

2021 ◽  
pp. 1-9
Author(s):  
Ankita Gupta ◽  
Budhi Singh Yadav ◽  
Nagarjun Ballari ◽  
Namrata Das ◽  
Ngangom Robert
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Progression Free Survival ◽  
Rank Test ◽  
Karnofsky Performance Score ◽  
Breast Cancer Patients ◽  
Free Survival ◽  
Prior Surgery

Abstract Background: Brain metastases (BM) are common in patients with HER2-positive and triple-negative breast cancer. In this study we aim to report clinical outcomes with LINAC-based stereotactic radiosurgery/radiotherapy (SRS/SRT) for BM in patients of breast cancer. Methods: Clinical and dosimetric records of breast cancer patients treated for BM at our institute between May, 2015 and December, 2019 were retrospectively reviewed. Patients of previously treated or newly diagnosed breast cancer with at least a radiological diagnosis of BM; 1–4 in number, ≤3·5 cm in maximum dimension, with a Karnofsky Performance Score of ≥60 were taken up for treatment with SRS. SRT was generally considered if a tumour was >3·5 cm in diameter, near a critical or eloquent structure, or if the proximity of moderately sized tumours would lead to dose bridging in a single-fraction SRS plan. The median prescribed SRS dose was 15 Gy (range 7–24 Gy) and SRT dose was 27 Gy in 3 fractions. Clinical assessment and MR imaging was done at 6 weeks post-SRS and then every 3 months thereafter. Intracranial progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan–Meier method and subgroups were compared using log rank test. Results: Total, 40 tumours were treated in 31 patients. The median tumour diameter was 2·3 cm (range 1·0–4·6 cm). SRS and SRT were delivered in 27 and 4 patients, respectively. SRS/SRT was given as a boost to whole brain radiotherapy (WBRT) in four patients and as salvage for progression after WBRT in six patients. In general, nine patients underwent prior surgery. The median follow-up was 7·9 months (0·2–34 months). Twenty (64·5%) patients developed local recurrence, 10 (32·3%) patients developed distant intracranial relapse and 7 patients had both local and distant intracranial relapse. The estimated local control at 6 months and 1 year was 48 and 35%, respectively. Median intracranial progression free survival (PFS) was 3·73 months (range 0·2–25 months). Median intracranial PFS was 3·02 months in patients who received SRS alone or as boost after WBRT, while it was 4·27 months in those who received SRS as salvage after WBRT (p = 0·793). No difference in intracranial PFS was observed with or without prior surgery (p = 0·410). Median overall survival (OS) was 21·7 months (range 0·2–34 months) for the entire cohort. Patients who received prior WBRT had a poor OS (13·31 months) as compared to SRS alone (21·4 months; p = 0·699). Conclusion: In patients with BM after breast cancer SRS alone, WBRT + SRS and surgery + SRS had comparable PFS and OS.

Sign in / Sign up

Export Citation Format

Share Document