Management of Brain and Leptomeningeal Metastases from Breast Cancer

Pellerino, Alessia; Internò, Valeria; Mo, Francesca; Franchino, Federica; Soffietti, Riccardo; Rudà, Roberta

doi:10.3390/ijms21228534

Cited by 23 publications

(24 citation statements)

References 145 publications

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“…Human epidermal growth factor receptor 2 (HER2) is overexpressed in approximately 15%–20% of patients with BC [ 2 ], of whom up to 50% develop brain metastases (BM), and 5% LM alone. Moreover, 43% of patients with BM may progress with secondary LM [ 3 ]. In general, LM from HER2-positive BC has a poor median overall survival (OS), ranging from 6.6 months for HER2+/estrogen receptor-positive (ER+) to 11.4 months for HER2+/ER negative BC, respectively [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Neratinib and Capecitabine for the Treatment of Leptomeningeal Metastases from HER2-Positive Breast Cancer: A Series in the Setting of a Compassionate Program

Pellerino

Soffietti

Bruno

et al. 2022

Cancers

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Background: Leptomeningeal metastasis is a neurological complication from HER2-positive breast cancer with a poor prognosis and limited treatment options. This study has evaluated the activity of neratinib in association with capecitabine in 10 patients with LM from HER2-positive BC after the failure of multiple lines of treatment, including trastuzumab-based therapy, within a compassionate program, and a comparison was made with a historical control group of 10 patients. Methods: Patients aged ≥ 18 years with histological diagnosis of primary HER2-positive BC, either amplified or mutated, and newly-diagnosed LM were enrolled. Coexistence of BM that has or has not received radiotherapy, as well as prior chemotherapy, hormone therapy, or monoclonal HER2-targeting antibodies or antibody–drug conjugates, were allowed, with the exclusion of lapatinib. Results: Six-months OS was 60% with a median OS of 10 months (95% CI: 2.00–17.0). Three-month intracranial PFS was 60% with a median intracranial PFS of 4.0 months (95% CI: 2.00–6.0). The neurological benefit was observed in 70% of patients with a median duration of neurological response of 6.5 months. The best radiological response was stable disease in 60% of patients. Conclusions: This small series shows that the combination of neratinib and capecitabine is a safe treatment in LM from heavily pretreated HER2-positive BC with clinical efficacy in some patients and is worth investigating in a larger study.

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Section: Introductionmentioning

confidence: 99%

Neratinib and Capecitabine for the Treatment of Leptomeningeal Metastases from HER2-Positive Breast Cancer: A Series in the Setting of a Compassionate Program

Pellerino

Soffietti

Bruno

et al. 2022

Cancers

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“…BM remain a largely unmet need in advanced breast cancer, particularly in HER2-positive and triple-negative disease. Improved control of extracranial disease through the use of anti-HER2 agents may increase the problem, something that further highlights the need to assess novel agents for their activity in the brain [ 27 ]. Recently, the U.S. Food and Drug Administration (FDA) approved tucatinib in combination with trastuzumab and capecitabine for patients with advanced HER2-positive breast cancer, including patients with BM, who have received one or more prior anti-HER2-based regimens for metastatic disease; importantly, this was the first FDA approval that specified BM in the indication statement [ 24 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Patient Eligibility and Results for Brain Metastasis in Phase 3 Trials of Advanced Breast Cancer: A Scoping Review

Duchnowska

Saad²,

Banaszek

et al. 2021

Cancers

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Background: Although brain metastases (BM) affect 5% of all breast cancer patients and 14% of those with metastatic disease, patients with BM are often excluded from participation in clinical trials. We conducted a structured assessment of the contemporary restrictions to enrolment of, and results for, patients with BM in phase 3 trials published over a period of 23 years in advanced breast cancer. Methods: We used PubMed to search for completed randomized trials published between 01/98 and 12/20. For all eligible trials, two authors independently abstracted data on general characteristics of the studies and detailed information on patient eligibility regarding the presence of BM. Results: We analyzed 210 trials, which enrolled 92,409 eligible patients. Of that total, 162 (77.1%) publications explicitly mentioned eligibility criteria related to the presence of BM and 75 (35.7%) trials reportedly allowed patients with BM, usually with restrictions related to prior brain treatment or stability of lesions. There was a significant increase over time in the percentages of trials allowing patients with BM (p < 0.001), and these trials were more frequently dedicated to HER2-positive or triple-negative disease (p = 0.001). Only 11 trials reported separate results for patients with BM at baseline. The direct treatment activity on BM was usually not reported, although in subgroup analyses the treatment effect in relative terms was usually better among patients with BM than in overall populations. Conclusion: Nearly 36% of phase 3 trials in advanced breast cancer over a 23-year period allowed patients with BM, and this practice is increasing over time. More research is needed to establish the activity of current and promising therapies in patients with BM.

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“…On the other hand, tru-cut biopsy provides a sample with preserved tissue architecture that allows comprehensive histological evaluation as well as permitting the collection of larger tissue samples, thus permitting other vital histological examinations, such as immunohistochemistry [ 18 ]. Obviously, this technique would require a larger-sized cutting needle in comparison to FNAB.…”

Section: Histological Examinationmentioning

confidence: 99%

The Role of Ultrasound Guided Sampling Procedures in the Diagnosis of Pelvic Masses: A Narrative Review of the Literature

et al. 2021

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Ultrasound-guided sampling methods are usually minimally invasive techniques applied to obtain cytological specimens or tissue samples, mainly used for the diagnosis of different types of tumors. The main benefits of ultrasound guidance is its availability. It offers high flexibility in the choice of sampling approach (transabdominal, transvaginal, and transrectal) and short duration of procedure. Ultrasound guided sampling of pelvic masses represents the diagnostic method of choice in selected patients. We carried out a narrative review of literatures regarding the ultrasound-guided methods of cytological and histological evaluation of pelvic masses as well as the positive and negative predictors for the achievement of an adequate sample.

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Management of Brain and Leptomeningeal Metastases from Breast Cancer

Cited by 23 publications

References 145 publications

Neratinib and Capecitabine for the Treatment of Leptomeningeal Metastases from HER2-Positive Breast Cancer: A Series in the Setting of a Compassionate Program

Neratinib and Capecitabine for the Treatment of Leptomeningeal Metastases from HER2-Positive Breast Cancer: A Series in the Setting of a Compassionate Program

Patient Eligibility and Results for Brain Metastasis in Phase 3 Trials of Advanced Breast Cancer: A Scoping Review

The Role of Ultrasound Guided Sampling Procedures in the Diagnosis of Pelvic Masses: A Narrative Review of the Literature

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