Long Survival in a Patient with Brain Metastases from Breast Cancer

Sanna, Giuseppina; Petralia, Giuseppe; Rocca, Maria Cossu; Marenghi, C.; Nolè, Franco

doi:10.4137/cmo.s317

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…In considerazione dei promettenti risultati degli studi clinici [1], si decide di avviare il trattamento chemioterapico di I linea con docetaxel 75 mg/m 2 , trastuzumab 8 mg/kg e pertuzumab 840 mg. Dopo 3 cicli, la prima rivalutazione evidenzia progressione di malattia con incremento dimensionale delle lesioni polmonari e peggioramento della sintomatologia. La paziente inizia pertanto una terapia di II linea con trastuzumab emtansine (TDM1) 3,6 mg/kg [2,3]. Dopo il 3° ciclo presenta episodi di cefalea, e a una nuova TC di rivalutazione si riscontra progressione di malattia a livello cerebrale.…”

Section: Approccio Terapeutico Alla Malattia Metastaticaunclassified

Response to Lapatinib-Capecitabine combination in a young patient with recurrent HER2-positive breast cancer refractory to two lines of therapy with anti-HER2 drugs

Savastano

Lombardi

2018

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HER2-positive breast cancer is an aggressive tumour that affects approximately one in five breast cancer women. Clinical studies have shown that HER2-positive cancer have different characteristics from other mammary tumors: a more rapid progression of the disease, an earlier age of onset (women of childbearing age between 30 and 45 are also affected to a large extent), a different response to chemotherapyand, in general, an unfavorable prognosis. Breast cancer with overexpression of the HER2 protein may benefit from the latest generation of target treatments (monoclonal antibodies and anti-HER2 tyrosine kinase inhibitors). Not all HER2-positive tumors, however, respond to therapies, and some responders may later become resistant. We report the case of a young woman with HER2-positive mammary carcinoma who presented resistance to the first two treatment lines with anti-HER2 drugs (trastuzumab-pertuzumab and TDM1) and responded to the combination lapatinib-capecitabine in third line (Oncology).

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Section: Approccio Terapeutico Alla Malattia Metastaticaunclassified

Response to Lapatinib-Capecitabine combination in a young patient with recurrent HER2-positive breast cancer refractory to two lines of therapy with anti-HER2 drugs

Savastano

Lombardi

2018

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“…The preponderance of clinical evidence combining SRS with targeted therapy in brain metastasis comes from retrospective studies and case reports [28][29][30]. These reports are summarized in Table 1 [31 -42].…”

Section: Prospective Assessment Of Srs and Targeted Therapies In Braimentioning

confidence: 99%

The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

et al. 2016

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Brain metastases are the most common intracranial malignancy. Many approaches, including radiation therapy, surgery, and cytotoxic chemotherapy, have been used to treat patients with brain metastases depending on the patient's disease burden and symptoms. However, stereotactic surgery (SRS) has revolutionized local treatment of brain metastases. Likewise, targeted therapies, including small-molecule inhibitors and monoclonal antibodies that target cancer cell metabolism or angiogenesis, have transformed managing systemic disease. Prospective data on combining these treatments for synergistic effect are limited, but early data show favorable safety and efficacy profiles.The combination of SRS and targeted therapy will further individualize treatment, potentially obviating the need for cytotoxic chemotherapy or whole-brain radiation.There is a great need to pursue research into these exciting modalities and novel combinations to further improve the treatment of patients with brain metastases.This article discusses reported and ongoing clinical trials assessing the safety and efficacy of targeted therapy during SRS. The Oncologist 2016;21:244-251 Implications for Practice: Treatment of patients with brain metastases requires a multidisciplinary approach. Stereotactic radiosurgery is increasingly used in the upfront setting to treat new brain metastasis. Targeted therapies have revolutionized systemic treatment of many malignancies and may sometimes be used as initial treatment in metastatic patients. There is sparse literature regarding safety and efficacy of combining these two treatment modalities. This article summarizes the supporting literature and highlights ongoing clinical trials in combining radiosurgery with targeted therapy.

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Real-world data of pyrotinib-based therapy for patients with brain metastases of HER2-positive advanced breast cancer: a single-center retrospective analysis and molecular portraits

et al. 2023

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IntroductionPyrotinib is a novel irreversible pan-HER tyrosine kinase inhibitor (TKI). However, real-world data of pyrotinib-containing therapy in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) and developing brain metastases (BMs) are limited, and the genomic profile of this subpopulation is almost undefined.Methods and materialsPatients with BM of HER2-positive MBC (n = 35) treated with pyrotinib-containing therapy were enrolled in this analysis. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and toxicity profiles were evaluated. Hazard ratios (HRs) and 95% confidence intervals (CIs) for disease progression were estimated using the Cox proportional hazards models. Targeted next-generation sequencing of 618 cancer-relevant genes was performed on plasma and primary breast tumors from patients with BM and without BM.ResultsThe median PFS time was 8.00 (95% CI, 5.98–10.017) months, and the median OS time was 23 (95% CI, 10.412–35.588) months. The ORR was 45.7%, and the DCR was 74.3%. In the Cox multivariate analysis, prior exposure to brain radiotherapy (HR = 3.268), received pyrotinib as third- or higher-line treatment (HR = 4.949), subtentorial brain metastasis (HR = 6.222), and both supratentorial and subtentorial brain metastases (HR = 5.863) were independently associated with increased risk of progression. The frequent grade 3–4 adverse event was increased direct bilirubin (14.3%), and two patients suffered from grade 3–4 diarrhea. In the exploratory genomic analysis, altered frequencies of FGFR3, CD276, CDC73, and EPHX1 were higher in the BM group. The consistency of mutated profiles of plasma and primary lesion in the BM group was significantly lower (30.4% vs. 65.5%; p = 0.0038).ConclusionsPyrotinib-containing therapy shows favorable effectiveness and tolerable safety in patients with BM of HER2-positive MBC, particularly in a population that is brain radiotherapy-naïve, received pyrotinib as first- or second-line treatment, and developed supratentorial brain metastasis. In the exploratory genomic analysis, patients with BM showed distinct genomic features from patients without BM.

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Long Survival in a Patient with Brain Metastases from Breast Cancer

Cited by 3 publications

References 19 publications

Response to Lapatinib-Capecitabine combination in a young patient with recurrent HER2-positive breast cancer refractory to two lines of therapy with anti-HER2 drugs

Response to Lapatinib-Capecitabine combination in a young patient with recurrent HER2-positive breast cancer refractory to two lines of therapy with anti-HER2 drugs

The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

Real-world data of pyrotinib-based therapy for patients with brain metastases of HER2-positive advanced breast cancer: a single-center retrospective analysis and molecular portraits

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