ALTHOUGH LOCAL TREATMENT FOR BRAIN METASTASES HAS ADVANCED, LIMITATIONS REMAIN1-6
Recurrence of brain metastases is a common threat, even after stabilization with local treatments1,2
IN A STUDY OF 84 PATIENTS
with newly diagnosed HER2-amplified breast cancer brain metastases who underwent SRS1:
~50% of patients
developed new brain metastases within
of SRS treatment
IN A STUDY OF 57 PATIENTS
with breast cancer with brain metastases who underwent SRS, of which 28 had HER2+ disease2:
1 in 2 patients
with HER2+ MBC (14/28) required salvage radiation therapy, including SRS (5/14) and WBRT (5/14)
A trend toward increased intracranial relapse in HER2+ patients vs HER2- patients was observed
Both SRS and WBRT may have serious side effects that negatively impact patient quality of life3-6
Side effects of SRS include3,4:
- FATIGUE
- NAUSEA
- HEADACHE
- COGNITIVE ISSUES
- HEARING IMPAIRMENT
- RADIONECROSIS
WBRT may cause serious, progressive, and irreversible side effects5,6
- Side effects may include inattention, confusion, memory loss, emotional dysfunction, coma, vascular injury/risk of stroke, and dementia
- Side effects may occur from months to years after treatment
BBB = blood-brain barrier; Da = dalton; HER = human epidermal growth factor receptor; IHC = immunohistochemistry; ISH = in situ hybridization; MBC = metastatic breast cancer; TN = triple-negative.
References: 1. Kim JM, Miller JA, Kotecha R, et al. Stereotactic radiosurgery with concurrent HER2-directed therapy is associated with improved objective response for breast cancer brain metastasis. Neuro Oncol. 2019;21(5):659-668. 2. Tam M, Narayana A, Raza S, et al. Role of HER2 status in the treatment for brain metastases arising from breast cancer with stereotactic radiosurgery. Med Oncol. 2014;31(2):832. 3. Brown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049-1060. 4. Donovan EK, Parpia S, Greenspoon JN. Incidence of radionecrosis in single-fraction radiosurgery compared with fractionated radiotherapy in the treatment of brain metastasis. Curr Oncol. 2019;26(3):e328-e333. 5. Aoyama H, Tago M, Kato N, et al. Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys. 2007;68(5):1388-1395. 6. Ramakrishna N, Temin S, Chandarlapaty S, et al. Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guidelines. J Clin Oncol. 2014;32(19):2100-2108.