Breast Cancer in the Central Nervous System: Multidisciplinary Considerations and Management

2017 ◽  
pp. 45-56 ◽  
Author(s):  
Nancy U. Lin ◽  
Laurie E. Gaspar ◽  
Riccardo Soffietti
Keyword(s):  
Breast Cancer ◽  
Central Nervous System ◽  
Nervous System ◽  
Brain Metastases ◽  
Multidisciplinary Treatment ◽  
Standards Of Care ◽  
Leptomeningeal Disease ◽  
Her2 Positive ◽  
Cancer Subtypes ◽  
New Findings

Breast cancer is the second most common primary tumor associated with central nervous system (CNS) metastases. Patients with metastatic HER2-positive or triple-negative (estrogen receptor (ER)–negative, progesterone receptor (PR)–negative, HER2-negative) breast cancer are at the highest risk of developing parenchymal brain metastases. Leptomeningeal disease is less frequent but is distributed across breast cancer subtypes, including lobular breast cancer. Initial treatment strategies can include surgery, radiation, intravenous or intrathecal chemotherapy, and/or targeted approaches. In this article, we review the epidemiology of breast cancer brain metastases, differences in clinical behavior and natural history by tumor subtype, and important considerations in the multidisciplinary treatment of these patients. We will highlight new findings that impact current standards of care, clinical controversies, and notable investigational approaches in clinical testing.

Predictive factors for oligometastatic versus non-oligometastatic involvement of the central nervous system by brain metastases from breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 123-123 ◽  
Author(s):  
S. Garg ◽  
J. C. Marsh ◽  
R. D. Rao ◽  
K. L. Griem
Keyword(s):  
Breast Cancer ◽  
Central Nervous System ◽  
Nervous System ◽  
Brain Metastases ◽  
Initial Diagnosis ◽  
Breast Cancer Patients ◽  
Cns Involvement ◽  
Cancer Subtypes ◽  
Oligometastatic Disease ◽  
The Central Nervous System

123 Background: To assess rates of oligometastatic (1-3 metastases) versus non-oligometastatic (4 or more) involvement of the central nervous system (CNS) from breast cancer and determine whether rates vary for different breast cancer subtypes. Methods: We reviewed records of 65 patients with brain metastases from breast cancer. Fisher’s Exact Test compared incidence of oligometastatic versus nonoligometastatic CNS involvement and presence of visceral metastatic disease between groups. Paired Student's t test compared mean age and interval from initial diagnosis to development of brain metastases. Results: 25 patients (38.5%) developed oligometastatic and 40 (61.5%) developed non-oligometastatic CNS disease. Subtypes predictive of oligometastatic disease included ER+ (p .04) and PR+ (p .008). Subtypes predictive of non-oligometastatic disease included HER2+ (p .05). HER2+ patients trended toward a lower incidence of visceral metastases compared to ER+ or PR+ patients (p .07). Non-oligometastatic and HER2+ patients developed brain metastases sooner after initial diagnosis (p .046 and .03, respectively). Conclusions: ER+ breast cancer patients are more likely to develop oligometastatic CNS involvement and may be excellent candidates for stereotactic radiosurgery (SRS) alone. HER+ patients are likely to develop non-oligometastatic CNS involvement and may be better treated initially with whole brain radiotherapy (WBRT) even with apparent initial oligometastatic CNS involvement.

scholarly journals Local and systemic treatment for HER2-positive breast cancer with brain metastases: a comprehensive review

2020 ◽  
Vol 12 ◽  
pp. 175883592095372
Author(s):  
Wing-Lok Chan ◽  
Tai-Chung Lam ◽  
Ka-On Lam ◽  
Mai-Yee Luk ◽  
Roger Ngan Kai-Cheong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Central Nervous System ◽  
Nervous System ◽  
Brain Metastases ◽  
Special Focus ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Systemic Treatments ◽  
Central Nervous System Metastases ◽  
Positive Breast Cancer

The management of human epidermal growth factor receptor (HER2)-positive breast cancer has improved over the past decade. However, despite improvements in systemic control, a substantial proportion of patients with advanced HER2-positive breast cancer suffer from central nervous system metastases and even intracranial progression after aggressive local treatment. There is paucity of data and no consensus on the systemic therapies for patients with intracranial progression. This review discusses both local and systemic treatments for HER2-positive breast cancer with brain metastases with a special focus on the response of central nervous system metastases. A recommended practical treatment algorithm to guide physicians in selecting the most appropriate anti-HER2 therapy for their patients is suggested.

scholarly journals Effect of Central Nervous System Metastases on Treatment Discontinuation and Survival in Older Women Receiving Trastuzumab for Metastatic Breast Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Mark D. Danese ◽  
Karla Lindquist ◽  
Justin Doan ◽  
Deepa Lalla ◽  
Melissa Brammer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Central Nervous System ◽  
Nervous System ◽  
Metastatic Breast Cancer ◽  
Proportional Hazards ◽  
Metastatic Breast ◽  
Cns Metastases ◽  
Her2 Positive ◽  
Time To Death ◽  
Risk Of Death

Background. Trastuzumab improves survival in HER2-positive women with metastatic breast cancer (MBC). The consequences of longer survival include a higher likelihood of additional metastases, including those in the central nervous system (CNS). The effect of CNS metastases on both trastuzumab discontinuation and survival in older patients has not been described.Patients and Methods. We used the Surveillance Epidemiology and End Results (SEER) Medicare data to identify a cohort of 562 women age 66 or older with MBC who were diagnosed between January 1, 2000 and December 31, 2005, free of CNS metastases, and initiated trastuzumab after MBC diagnosis. Time to discontinuation and time to death were analyzed using proportional hazards models.Results. Newly diagnosed CNS metastases were associated with both higher risk of trastuzumab discontinuation (relative hazard[RH]=1.78, 95% CI 1.11–2.87) and higher risk of death (RH=2.49, 95% CI 1.84–3.37). The incidence rate of new CNS metastases was comparable among various sites of metastasis (10.7 to 14.7 per 1,000 patient-months), except for bone which was higher (24.1 per 1,000).Conclusion. The diagnosis of CNS metastases was associated with an increase in both the likelihood of discontinuing trastuzumab therapy as well as the risk of death.

scholarly journals Breast cancer subtypes and outcomes of central nervous system metastases

The Breast ◽  
2011 ◽  
Vol 20 (6) ◽  
pp. 562-567 ◽  
Author(s):  
Ulku Y. Arslan ◽  
Berna Oksuzoglu ◽  
Sercan Aksoy ◽  
Hakan Harputluoglu ◽  
Ibrahim Turker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Central Nervous System ◽  
Nervous System ◽  
Breast Cancer Subtypes ◽  
Cancer Subtypes ◽  
Central Nervous System Metastases

scholarly journals Systemic control of cerebral metastases in a patient with HER2-positive metastatic breast cancer. Clinical case

2019 ◽  
pp. 129-134
Author(s):  
S. F. Menshikova ◽  
M. A. Frolova ◽  
M. B. Stenina
Keyword(s):  
Breast Cancer ◽  
Central Nervous System ◽  
Nervous System ◽  
Metastatic Breast Cancer ◽  
Blood Brain Barrier ◽  
Metastatic Breast ◽  
Brain Barrier ◽  
Cns Metastases ◽  
Her2 Positive ◽  
Blood Brain

Symptomatic central nervous system (CNS) metastases are diagnosed in 10–16% of patients with metastatic breast cancer (BC). Half of all these cases are HER2-positive. At present, there are no generally accepted algorithms regarding the combination and sequence of local and systemic treatment options for these patients. According to current guidelines, different local management options remain one of the main treatment methods of brain metastases control. When local treatment is limited, patients with HER2-positive BC with СNS metastases can receive anti-HER2 therapy in combination with chemo- or hormonal therapy (for luminal tumors) or as single option. Trastuzumab poorly penetrates the blood-brain barrier, but trastuzumab-based treatment schedules increase the life expectancy in patients with HER2-positive BC with CNS metastases mainly due to control of extracranial metastases. Lapatinib, by contrast, penetrates the blood-brain barrier well, and its combination with capecitabine achieves response in heavily pretreated patients, especially in those who have central nervous system metastases as the only site of disease progression.

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