Radionecrosis after stereotactic radiotherapy for brain metastases

Rhun, Émilie Le; Dhermain, Frédéric; Vogin, Guillaume; Reyns, Nicolas; Métellus, Philippe

doi:10.1080/14737175.2016.1184572

Cited by 84 publications

(75 citation statements)

References 100 publications

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“…The most commonly reported AEs in both groups was radiation necrosis (RN) with an incidence of 50% and 28.6%, for both T-DM1 during treatment and T-DM1 discontinued before SRS, respectively. Therefore, the combination of T-DM1 with SRS induced a clinically relevant increase in the risk of RN, when compared to previously published data [38][39][40]. Moreover, Carlson et al [40] found an association with cerebral swelling in patients on T-DM1 who underwent SRS.…”

Section: T-dm1 and Stereotactic Radiosurgerymentioning

confidence: 60%

Adverse Events of Trastuzumab Emtansine (T-DM1) in the Treatment of HER2-Positive Breast Cancer Patients

et al. 2017

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The human epidermal growth factor receptor 2 (HER2) is commonly associated with poor prognosis and is overexpressed in approximately 15-20% of all breast cancers. The introduction of HER2-targeted therapies led to significant improvement in the prognosis of patients with HER2-positive breast cancer, for both early and advanced disease. These targeted therapies include the antibodies trastzumab and pertuzumab, the tyrosine kinase inhibitor lapatinib, and the antibody-drug conjugate trastuzumab emtansine (T-DM1). T-DM1 combines the anti-tumor activity of trastuzumab with that of DM1, a highly potent derivative of the anti-microtubule agent maytansine, resulting in increased anti-tumor activity. Notably, this agent has been demonstrated to be safe and is associated with low toxicity rates. However, maytansinoid, the cytotoxic component of T-DM1, does have the potential to induce various adverse events, particularly radiation necrosis, when used in combination with stereotactic radiosurgery. In this review, we aimed to summarize the current literature regarding T-DM1 safety and toxicity, with special emphasis on the existing landmark studies.

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Section: T-dm1 and Stereotactic Radiosurgerymentioning

confidence: 60%

Adverse Events of Trastuzumab Emtansine (T-DM1) in the Treatment of HER2-Positive Breast Cancer Patients

et al. 2017

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“…Radiation is targeted to the entire brain (whole brain radiation therapy, WBRT) or to a specific area of the brain (stereotactic radiotherapy). Though radiation may cause potential side effects such as cognitive impairment and radionecrosis of exposed brain tissue, resection followed by WBRT offers acceptable control of local disease (64). Treatment planning depends on the size, location, and number of metastases.…”

Section: Implications For Therapeuticsmentioning

confidence: 99%

Metabolic advantages and vulnerabilities in brain metastases

Ciminera

Jandial

Termini

2017

Clin Exp Metastasis

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Metabolic adaptations permit tumor cells to metastasize to and thrive in the brain. Brain metastases continue to present clinical challenges due to rising incidence and resistance to current treatments. Therefore, elucidating altered metabolic pathways in brain metastases may provide new therapeutic targets for the treatment of aggressive disease. Due to the high demand for glucose in the brain, increased glycolytic activity is favored for energy production. Primary tumors that undergo Warburg-like metabolic reprogramming become suited to growth in the brain microenvironment. Indeed, elevated metabolism is a predictor of metastasis in many cancer subtypes. Specifically, metabolic alterations are seen in primary tumors that are associated with the formation of brain metastases, namely breast cancer, lung cancer, and melanoma. Because of this selective pressure, inhibitors of key metabolic factors may reduce tumor cell viability, thus exploiting metabolic pathways for cancer therapeutics. This review summarizes the metabolic advantages and vulnerabilities of brain metastases.

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“…30 Recent data suggests that RN rates may be increased in patients who receive concomitant immunotherapy with SRS. 31 …”

Section: Radiation Therapymentioning

confidence: 99%

Melanoma Brain Metastases

2017

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Metastases to the central nervous system (CNS) are one of the most common and lethal complications of metastatic melanoma. Historically, melanoma patients with CNS metastases have had dismal outcomes and very limited treatment options. However, the development of more effective targeted, immune, and radiation therapies is now leading to promising new investigations and strategies. Optimizing the development and testing of such strategies will benefit from an improved understanding of the unique molecular features of these tumors and the influence of the brain microenvironment. Accounting for unique clinical features and challenges of CNS metastases will also be critical to making significant clinical impact in patients.

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Radionecrosis after stereotactic radiotherapy for brain metastases

Cited by 84 publications

References 100 publications

Adverse Events of Trastuzumab Emtansine (T-DM1) in the Treatment of HER2-Positive Breast Cancer Patients

Adverse Events of Trastuzumab Emtansine (T-DM1) in the Treatment of HER2-Positive Breast Cancer Patients

Metabolic advantages and vulnerabilities in brain metastases

Melanoma Brain Metastases

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