High incidence of brain metastases at the time of death in women with metastatic breast cancer treated with trastuzumab

The Effect of Early Detection of Occult Brain Metastases in HER2-Positive Breast Cancer Patients on Survival and Cause of Death

“…In a group of patients with HER2 overexpression, the incidence of symptomatic brain metastases is even higher, reaching 24% to 48% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). In our series occult brain metastases were found in 36% of patients.…”

“…Prevention of severe neurologic symptoms or even prolonged survival is expected. Prophylactic cranial irradiation in patients with complete response to trastuzumab or in HER2-positive breast cancer patients after completion of adjuvant therapy is also discussed (1,3,5,18). According to standard protocols, routine brain screening in asymptomatic patients with disseminated disease is not performed because, up to now, no convincing data to support the benefit related to early diagnosis and treatment of brain metastases have been available (18,19).…”

“…HER2-positive breast carcinoma is a more aggressive subtype of breast cancer (1-3), leading to a higher risk of dissemination to the central nervous system (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Systemic chemotherapy and targeted therapy have improved response rates and extended survival rates.…”

Occult brain metastases in HER2-positive breast cancer patients: Frequency and response to radiotherapy

“…Unfortunately, the concentration of trastuzumab in cerebrospinal fluid is low and, therefore, significant regression of visceral disease and, parallel to it, progression of the disease within the central nervous system (CNS) has been frequently observed [3]. In view of these facts, early recognition of cerebral metastases and the immediate application of palliative radiotherapy of the brain could delay life-threatening neurological complications and maybe even increase overall survival [2,4].…”

Trastuzumab treatment improves brain metastasis outcomes through control and durable prolongation of systemic extracranial disease in HER2-overexpressing breast cancer patients

“…Historically, the lack of durability for CNS control was not a problem for most patients because BMs occurred late in the course of illness, and progression in non-CNS was the dominant cause of morbidity and mortality (Herrero et al, 2004;Bartsch et al, 2007). However, as systemic therapies improve, the control of CNS disease seems to become increasingly important for overall disease control.…”