Clinical Outcomes of Breast Cancer Patients with HER2-positive Brain Metastases Treated with Stereotactic Radiation and Trastuzumab Emtansine

Mills, M.; Walker, Chelsea; Thawani, Chetna; Naz, Afrin; Figura, Nicholas; Yu, Mingwei; Robinson, T.; Etame, Arnold B.; Liu, J.K.; Vogelbaum, Michael A.; Forsyth, Peter; Soliman, Hany; Han, Hyo S.; Ahmed, KA

doi:10.1016/j.ijrobp.2020.07.2026

Cited by 2 publications

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“…The cornerstone of the treatment of BM consists of local treatment modalities like surgery and/or stereotactic radiotherapy, often combined with systemic treatment. Besides a direct cytotoxic effect, systemic treatments can also exert a radio-sensitizing effect [ 10 , 11 , 12 , 13 ]. Systemic therapies for patients with HER2+ mBC include chemotherapy (e.g., taxanes), monoclonal antibodies (mAbs; eg.…”

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confidence: 99%

Systemic Therapy for Patients with HER2-Positive Breast Cancer and Brain Metastases: A Systematic Review and Meta-Analysis

Werter

Remmelzwaal

Burchell

et al. 2022

Cancers

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Aim: Patients with HER2-positive (HER2+) metastatic breast cancer (mBC) develop brain metastases (BM) in up to 30% of cases. Treatment of patients with BM can consist of local treatment (surgery and/or radiotherapy) and/or systemic treatment. We undertook a systematic review and meta-analysis to determine the effect of different systemic therapies in patients with HER2+ mBC and BM. Methods: A systematic search was performed in the databases PubMed, Embase.com, Clarivate Analytics/Web of Science Core Collection and the Wiley/Cochrane Library. Eligible articles included prospective or retrospective studies reporting on the effect of systemic therapy on objective response rate (ORR) and/or median progression free survival (mPFS) in patients with HER2+ mBC and BM. The timeframe within the databases was from inception to 19 January 2022. Fixed-effects meta-analyses were used. Quality appraisal was performed using the ROBINS-I tool. Results: Fifty-one studies were included, involving 3118 patients. Most studies, which contained the largest patient numbers, but also often carried a moderate-serious risk of bias, investigated lapatinib and capecitabine (LC), trastuzumab-emtansine (T-DM1) or pyrotinib. The best quality data and/or highest ORR were described with tucatinib (combined with trastuzumab and capecitabine, TTC) and trastuzumab-deruxtecan (T-DXd). TTC demonstrated an ORR of 47.3% in patients with asymptomatic and/or active BM. T-DXd achieved a pooled ORR of 64% (95% CI 43–85%, I2 0%) in a heavily pretreated population with asymptomatic BM (3 studies, n = 96). Conclusions: Though our meta-analysis should be interpreted with caution due to the heterogeneity of included studies and a related serious risk of bias, this review provides a comprehensive overview of all currently available systemic treatment options. T-Dxd and TTC that appear to constitute the most effective systemic therapy in patients with HER2+ mBC and BM, while pyrotinib might be an option in Asian patients.

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