Chemotherapy in breast cancer patients with brain metastases: Have new chemotherapic agents changed the clinical outcome?

Tosoni, Alicia; Franceschi, Enrico; Brandes, Alba A.

doi:10.1016/j.critrevonc.2008.04.004

Cited by 30 publications

(26 citation statements)

References 77 publications

(89 reference statements)

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“…The ER-negative status of BC has been pinpointed by different authors as a risk factor of LM [5]. In addition, ERnegative or PR-negative status is a risk factor for CNS metastasis [1,2,5,7,8,[14][15][16][17]. In our cohort, the HER2 receptor was over-expressed in 26% of cases, which was not significantly associated with the development of LM (P = 0.51).…”

Section: Discussionmentioning

confidence: 70%

“…In the literature, the HER2 receptor is overexpressed in 20-30% of all BC patients and 44-49% of BC patients with secondary brain metastases [5,18,19]. Overexpression of HER2 seems to triple the risk of brain metastasis and also seems to affect the time it takes for detection and prognosis of brain metastases [2,9,10,16,17,20]. In our cohort, we mainly observed lobular cancers, whose HER2 expression is known to be less frequent and may explain the non-significant correlation between HER2 status and the presence of LM [21].…”

Section: Discussionmentioning

confidence: 98%

“…technology and advances in therapy [1,2]. Longer control of the systemic disease provides more time for the potential development of CNS metastases, and the use of new and non-crossing intact leptomeningeal-blood barrier agents, given either in the adjuvant or metastatic setting, may improve overall cancer survival while increasing the incidence of CNS metastases [3].…”

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confidence: 99%

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Clinicopathological features of breast cancers predict the development of leptomeningeal metastases: a case-control study

et al. 2011

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The incidence of leptomeningeal metastases (LM) in patients with breast cancer (BC) is increasing as a result of increased screening and improved patient survival. However, the median survival time after diagnosis of LM is between 5 weeks (without any treatment) and 5 months (for aggressively treated patients). In an attempt to identify clinicopathological risk factors for LM, we carried out a case-control study of 100 women with BC. Fifty patients with BC and LM were enrolled and an additional 50 patients with BC and no CNS metastases including leptomeningeal spread were selected as controls. Patients who had developed LM were selected between December 2006 and August 2008. The control group was matched for: age at diagnosis, year of diagnosis, and initiation of chemotherapy at BC diagnosis. The ILC type (P = 0.03), ER-negative (P = 0.01) and PR-negative status (P = 0.03), and initial M+ status at BC diagnosis (P = 0.008) tended to be more frequent in LM patients. These characteristics should lead to early appropriate assessments being performed in this targeted population when a neurological complaint appears, in order to detect LM as soon as possible.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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Clinicopathological features of breast cancers predict the development of leptomeningeal metastases: a case-control study

et al. 2011

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“…However, management of brain metastases remains a significant challenge (1,2). First-line local treatment modalities for brain metastases include whole-brain radiotherapy (WBRT), stereotactic surgery, and surgical operation.…”

Section: Introductionmentioning

confidence: 99%

Bevacizumab Preconditioning Followed by Etoposide and Cisplatin Is Highly Effective in Treating Brain Metastases of Breast Cancer Progressing from Whole-Brain Radiotherapy

Chen

Lin

et al. 2015

Clinical Cancer Research

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Purpose: We hypothesized that a window period between bevacizumab and cytotoxic agents may enhance drug delivery into tumor tissue through bevacizumab-induced vascular normalization in patients with brain metastases of breast cancer (BMBC).Experimental Design: A single-arm phase II study was conducted in which BMBC patients refractory to whole-brain radiotherapy (WBRT) were enrolled. In a 21-day cycle, patients received bevacizumab (15 mg/kg) on day 1, which, with a 1-day window period, was followed by etoposide (70 mg/m 2 /day; days 2-4) and cisplatin (70 mg/m 2 ; day 2; BEEP regimen). The BEEP regimen was administered for a maximum of 6 cycles. The primary endpoint was the central nervous system (CNS)-objective response rate according to volumetric response criteria.Results: A total of 35 patients were enrolled between January 2011 and January 2013. The median age was 54.3 years (range, 33-75); 19 patients (54.3%) had an Eastern Cooperative Oncology Group performance status of 2 or 3. Twenty-seven patients [77.1%; 95% confidence interval (CI), 59.9-89.6] achieved a CNS-objective response, including 13 patients (37.1%) with a !80% volumetric reduction of CNS lesions. With a median follow-up of 16.1 months, the median CNS progression-free survival and overall survival times were 7.3 months (95% CI, 6.5-8.1) and 10.5 months (95% CI, 7.8-13.2), respectively. Common grade 3 or 4 toxicities included neutropenia (30.8%) and infection (21.3%).Conclusions: By administering bevacizumab 1 day before etoposide and cisplatin, the BEEP regimen appeared highly effective in BMBC refractory to WBRT. Further study of vascular normalization window concept is warranted.

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“…1 Poor prognosis is in fact associated with both primary and secondary CNS tumors. If patients with CNS metastases are virtually incurable and likely to have short survival, primary CNS cancers can be surgically cured depending on disease stage and histotype.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation in Neuro-Oncology: A Meta-Analysis of Published Data and a Mono-Institutional Experience

Formica

Monte²,

Giacchetti

et al. 2010

Integr Cancer Ther

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Background. Rehabilitation for cancer patients with central nervous system (CNS) involvement is rarely considered and data on its use are limited. The purpose of the present study is to collect all available published data on neuro-oncology rehabilitation and perform a meta-analysis where results were presented in a comparable manner. Moreover, the authors report results on cancer patients with neurological disabilities undergoing rehabilitation at their unit. Study design. A PubMed search was performed to identify studies regarding cancer patients with CNS involvement undergoing inpatient physical rehabilitation. Studies with a complete functional evaluation at admission and discharge were selected. As the most common evaluation scales were Functional Independence Measure (FIM) and Barthel Index (BI), only articles with complete FIM and/or BI data were selected for the meta-analysis. Moreover, 23 cancer patients suffering from diverse neurological disabilities underwent standard rehabilitation program between April 2005 and December 2007 at the San Raffaele Pisana Rehabilitation Center. Patient demographics and relevant clinical data were collected. Motricity Index, Trunk Control Test score, and BI were monitored during rehabilitation to assess patient progresses. BI results of patients in this study were included in the meta-analysis. Results. The meta-analysis included results of a total of 994 patients. A statistically significant (P < .05) improvement of both BI and FIM scores was demonstrated after rehabilitation (standardized mean difference = 0.60 and 0.75, respectively). Functional status determined by either FIM or BI improved on average by 36%. Conclusion. Published data demonstrate that patients with brain tumors undergoing inpatient rehabilitation appear to make functional gains in line with those seen in similar patients with nonneoplastic conditions.

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Chemotherapy in breast cancer patients with brain metastases: Have new chemotherapic agents changed the clinical outcome?

Cited by 30 publications

References 77 publications

Clinicopathological features of breast cancers predict the development of leptomeningeal metastases: a case-control study

Clinicopathological features of breast cancers predict the development of leptomeningeal metastases: a case-control study

Bevacizumab Preconditioning Followed by Etoposide and Cisplatin Is Highly Effective in Treating Brain Metastases of Breast Cancer Progressing from Whole-Brain Radiotherapy

Rehabilitation in Neuro-Oncology: A Meta-Analysis of Published Data and a Mono-Institutional Experience

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