EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours

Rhun, Émilie Le; Gückenberger, Matthias; Smits, Marion; Dummer, Reinhard; Bachelot, Thomas; Sahm, Felix; Galldiks, Norbert; Azambuja, Evandro de; Berghoff, Anna Sophie; Métellus, Philippe; Peters, Solange; Hong, Yong Kil; Winkler, Frank; Schadendorf, Dirk; Bent, Martin van den; Seoane, Joan; Stahel, Rolf A.; Minniti, Giuseppe; Wesseling, Pieter; Weller, Michael

doi:10.1016/j.annonc.2021.07.016

Cited by 334 publications

(325 citation statements)

References 95 publications

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“…Nowadays, SRS plays an increasingly important role in radiotherapy of patients with BMs. According to the latest guideline [ 10 ], for patients with oligo-BMs, SRS was recommended as preferred radiotherapy mode. Moreover, SRS could also be considered for patients with 4–10 BMs and cumulative tumor volume less than 15 ml or after complete or incomplete resection of BMs.…”

Section: Discussionmentioning

confidence: 99%

“…Not only for patients with oligo-BMs, but also for patients with 4–10 BMs with a cumulative tumor volume of fewer than 15 ml, SRS could also be recommended. WBRT, as an alternative scheme, could be selected for patients with multiple BMs not eligible for SRS, in line with performance status, number, and location of BMs, and neural symptoms [ 10 ]. Nevertheless, WBRT is the primary radiotherapy method for patients with leptomeningeal metastases (LM), though whether it could extend survival remains debatable.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic effect of osimertinib plus cranial radiotherapy compared to osimertinib alone in NSCLC patients with EGFR-activating mutations and brain metastases: a retrospective study

Zhai

et al. 2021

Radiat Oncol

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Background The study aimed to compare the efficacy of osimertinib plus cranial radiotherapy (RT) with osimertinib alone in advanced non-small-cell lung cancer (NSCLC) patients harboring epidermal growth factor receptor (EGFR) mutations and brain metastases (BMs). Methods The clinical data of advanced NSCLC patients with BMs who received osimertinib were retrospectively collected. The patients were assigned to one of the two groups according to the therapeutic modality used: the osimertinib monotherapy group or the osimertinib plus RT group. Results This was a retrospective study and 61 patients were included from December 2015 to August 2020. Forty patients received osimertinib monotherapy, and twenty-one patients received osimertinib plus RT. Radiotherapy included whole-brain radiation therapy (WBRT, n = 14), WBRT with simultaneous integrated boost (WBRT-SIB, n = 5) and stereotactic radiosurgery (SRS, n = 2). The median number of prior systemic therapies in the two groups was one. Intracranial and systemic ORR and DCR were not significantly different between the two groups. No difference in iPFS was observed between the two groups (median iPFS: 16.67 vs. 13.50 months, P = 0.836). The median OS was 29.20 months in the osimertinib plus RT group compared with 26.13 months in the osimertinib group (HR = 0.895, P = 0.826). In the L858R mutational subgroup of 31 patients, the osimertinib plus RT group had a longer OS (P = 0.046). In the exon 19 deletion mutational subgroup of 30 patients, OS in the osimertinib alone group was longer than that in the osimertinib plus RT group (P = 0.011). The incidence of any-grade adverse events was not significantly different between the osimertinib plus RT group and the osimertinib alone group (47.6% vs. 32.5%, P = 0.762). However, six patients (28.5%) experienced leukoencephalopathy in the osimertinib plus RT group, and 50% (3/6) of the leukoencephalopathy was greater than or equal to grade 3. Conclusion The therapeutic effect of osimertinib with RT was similar to that of osimertinib alone in EGFR-positive NSCLC patients with BM. However, for patients with the L858R mutation, osimertinib plus RT could provide more benefit than osimertinib alone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Therapeutic effect of osimertinib plus cranial radiotherapy compared to osimertinib alone in NSCLC patients with EGFR-activating mutations and brain metastases: a retrospective study

Zhai

et al. 2021

Radiat Oncol

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“…Based on the new European Association of Neuro-Oncology (EANO)–European Society for Medical Oncology (ESMO) clinical practice guidelines, a systemic therapy can play an important role in the control of brain metastases from breast cancer and it should be considered for most patients with initial brain metastases, not only after an intracranial recurrence. In asymptomatic brain metastases, a systemic treatment should be considered to delay WBRT [ 83 ].…”

Section: Discussionmentioning

confidence: 99%

Intracranial Response Rate in Patients with Breast Cancer Brain Metastases after Systemic Therapy

Niwińska

Pogoda

Jagiełło-Gruszfeld

et al. 2022

Cancers

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Brain metastases are detected in 5% of patients with breast cancer at diagnosis. The rate of brain metastases is higher in HER2-positive and triple-negative breast cancer patients (TNBC). In patients with metastatic breast cancer, the risk of brain metastases is much higher, with up to 50% of the patients having two aggressive biological breast cancer subtypes. The prognosis for such patients is poor. Until recently, little was known about the response to systemic therapy in brain metastases. The number of trials dedicated to breast cancer with brain metastases was scarce. Our review summarizes the current knowledge on this topic including very significant results of clinical trials which have been presented very recently. We focus on the intracranial response rate of modern drugs, including new antibody–drug conjugates, HER2- targeted tyrosine kinase inhibitors and other targeted therapies. We highlight the most effective and promising drugs. On the other hand, we also suggest that further efforts are needed to improve the prognosis, especially patients with TNBC and brain metastases. The information contained in this article can help oncologists make treatment-related decisions.

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“…The initial treatment of symptomatic brain metastases (BM) is traditionally local with neurosurgery and/or radiotherapy, depending on the number of metastases, performance status, and systemic disease control. 16 These techniques provide good local control but do not effectively prevent future CNS events. An exploratory analysis of the CLEOPATRA trial showed longer median time to development of CNS metastases as first site of disease progression in pertuzumab arm (15.0 versus 11.9 months, HR 0.58, 95% CI 0.39-0.85), 17 meaning that despite the low blood–brain barrier (BBB) permeability, these monoclonal antibodies still play a role in first-line MBC with BM.…”

Section: Relapse With Central Nervous System Metastasesmentioning

confidence: 99%

How we treat patients with metastatic HER2-positive breast cancer

2022

Self Cite

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HER2-positive breast cancer represents 15%-20% of breast malignancies and is characterized by an aggressive behavior and high recurrence rates. Anti-HER2-directed agents represent the mainstay of treatment of patients with HER2-positive metastatic breast cancer (MBC). In this review we propose a treatment algorithm for patients with HER2-positive MBC based on the currently available literature on the topic. The combination of trastuzumab, pertuzumab and a taxane (THP) remains the preferred first-line therapy in most scenarios. Results of trials recently presented at the European Society for Medical Oncology (ESMO) Congress 2021 might have direct clinical impact in the second- and later-line settings. The randomized DESTINY-BREAST03 study compared trastuzumab deruxtecan (T-DXd) with trastuzumab emtansine (T-DM1) in patients previously treated with trastuzumab and a taxane. T-DXd significantly improved progression-free survival and showed a trend towards improved overall survival, establishing this agent as preferred second-line therapy. Treatment with T-DM1, or the combination of tucatinib, trastuzumab and capecitabine, are considered reasonable options after second-line therapy. For subsequent lines, trastuzumab duocarmazine, neratinib plus capecitabine or the continuation of trastuzumab with different chemotherapy partners are valid options. For patients experiencing disease relapse up to 6 months after completion of adjuvant therapy, as well as for those relapsing within 12 months from the completion of pertuzumab-based adjuvant treatment, we recommend T-DXd as preferred first-line option. For those relapsing between 6 and 12 months after non-pertuzumab-based adjuvant treatment, we recommend first-line THP. Finally, for patients with active brain metastasis, tucatinib-based combination represents a suitable second-line option.

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EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours

Cited by 334 publications

References 95 publications

Therapeutic effect of osimertinib plus cranial radiotherapy compared to osimertinib alone in NSCLC patients with EGFR-activating mutations and brain metastases: a retrospective study

Therapeutic effect of osimertinib plus cranial radiotherapy compared to osimertinib alone in NSCLC patients with EGFR-activating mutations and brain metastases: a retrospective study

Intracranial Response Rate in Patients with Breast Cancer Brain Metastases after Systemic Therapy

How we treat patients with metastatic HER2-positive breast cancer

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