Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases

Mills, Matthew; Thawani, Chetna; Figura, Nicholas; Oliver, Daniel; Soyano, Aixa; Etame, Arnold B.; Robinson, Timothy J.; Liu, James K.; Vogelbaum, Michael A.; Czerniecki, Brian J.; Soliman, Hatem; Han, Hyo S.; Yu, Hsiang-Hsuan Michael; Ahmed, Kamran A.

doi:10.1007/s11060-021-03735-5

Cited by 9 publications

(7 citation statements)

References 44 publications

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“…The significantly longer DBFFS for patients who expressed HER2 in their CTC observed in our study is in line with previous findings of lower DBF in patients being PIP HER2-positive [6,14,15]. Vern-Gross et al evaluated the patterns of failure of BCBM after SRT and revealed that the breast cancer subtype predicted the DBF rate, with significantly lower rates for patients with PIP HER2 and luminal HER2 [14].…”

Section: Discussionsupporting

confidence: 92%

“…Between November 2016 and February 2018, 39 women were accrued. Patients underwent SRT with radiosurgery (SRS) or stereotactic fractionated radiotherapy (SFRT) in 68% (27) and 31% (12) of cases, respectively, with a median prescribed dose of 20 Gy (15)(16)(17)(18)(19)(20)(21)(22) with SRS and 27.5 Gy (25-30) in five fractions with SFRT.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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Heterogeneity of HER2 Expression in Circulating Tumor Cells of Patients with Breast Cancer Brain Metastases and Impact on Brain Disease Control

Castro

Pellizzon

Braun

et al. 2022

Cancers

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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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Section: Discussionsupporting

confidence: 92%

Section: Baseline Characteristicsmentioning

confidence: 99%

Heterogeneity of HER2 Expression in Circulating Tumor Cells of Patients with Breast Cancer Brain Metastases and Impact on Brain Disease Control

Castro

Pellizzon

Braun

et al. 2022

Cancers

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“…Patients were evaluated during follow-up 4–6 weeks after fSRT and subsequently every 2–3 months with MRI re-imaging. Response was evaluated on a “per lesion” basis as in other studies investigating BM response to SRT [ 21 , 22 , 23 ]. For brain metastases measuring ≥ 5 mm, intracranial complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were determined by MRI according to the response evaluation criteria in solid tumors (RECIST v 1.1) as follows: CR was defined as the disappearance of the target lesion; PR has at least a 30% decrease in the sum of diameters of the target lesion; PD has at least a 20% increase in the sum of diameters of the target lesion; SD has neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Stereotactic Radiation and Dual Human Epidermal Growth Factor Receptor 2 Blockade with Trastuzumab and Pertuzumab in the Treatment of Breast Cancer Brain Metastases: A Single Institution Series

Ippolito

Silipigni

Matteucci

et al. 2022

Cancers

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(1) Background: This study aims to assess the safety and efficacy of fractionated SRT (fSRT) and pertuzumab–trastuzumab (PT) in patients with breast cancer brain metastases (BCBM). (2) Methods: Patients with HER2+ BCBM who received FSRT from 2015 to 2019 were identified. Patients were included if they were treated with fSRT within 21 days of receiving PT. All lesions were treated with LINAC-based fSRT to a total dose of 27 Gy delivered in three consecutive fractions. All patients received concurrent PT. Patients were evaluated 4–6 weeks after SRS and subsequently every 2–3 months with MRI re-imaging (3) Results: A total of 49 patients with HER2+ brain metastases were identified. Of these patients, a total of 10 patients with 32 HER2+ BCBM were treated with concurrent SRT and PT and included in the analysis. No local progression was observed. Overall response rate was 68.7%. Only one patient developed asymptomatic radionecrosis. Median time to BM occurrence was 15.6 (range: 1–40.5 months). Distant intracranial failure occurred in 4/10 patients (40.0%). Overall BCBM median survival was 33.9 months (95%CI 24.1–43.6). Mean duration of PT treatment was 27.9 months (range: 10.1–53.7 months). (4) Conclusions: In our single institution experience, fSRT and PT showed to be a safe treatment for patients with BCBM with an adequate overall response rate.

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“…A study by Mills et al. reported HR positive breast cancers patients with hormonal therapy prior to stereotactic radiotherapy (SRT) report 2-year overall survival as low as 24% ( 58 ), however there is little literature investigating concurrent SRS with systemic endocrine therapy.…”

Section: Introductionmentioning

confidence: 99%

Improving Brain Metastases Outcomes Through Therapeutic Synergy Between Stereotactic Radiosurgery and Targeted Cancer Therapies

et al. 2022

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Brain metastases are the most common form of brain cancer. Increasing knowledge of primary tumor biology, actionable molecular targets and continued improvements in systemic and radiotherapy regimens have helped improve survival but necessitate multidisciplinary collaboration between neurosurgical, medical and radiation oncologists. In this review, we will discuss the advances of targeted therapies to date and discuss findings of studies investigating the synergy between these therapies and stereotactic radiosurgery for non-small cell lung cancer, breast cancer, melanoma, and renal cell carcinoma brain metastases.

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Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases

Cited by 9 publications

References 44 publications

Heterogeneity of HER2 Expression in Circulating Tumor Cells of Patients with Breast Cancer Brain Metastases and Impact on Brain Disease Control

Heterogeneity of HER2 Expression in Circulating Tumor Cells of Patients with Breast Cancer Brain Metastases and Impact on Brain Disease Control

Stereotactic Radiation and Dual Human Epidermal Growth Factor Receptor 2 Blockade with Trastuzumab and Pertuzumab in the Treatment of Breast Cancer Brain Metastases: A Single Institution Series

Improving Brain Metastases Outcomes Through Therapeutic Synergy Between Stereotactic Radiosurgery and Targeted Cancer Therapies

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