Management of brain metastases from breast cancer by combination chemotherapy

Rosner, Dutzu; Nemoto, Takuma; Pickren, John W.; Lane, Warren W.

doi:10.1007/bf00182958

Cited by 43 publications

(13 citation statements)

References 23 publications

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“…Previous reports have recommended a more aggressive and systemic approach to treatment of patients with brain metastases [24,25]. This study supports these findings, since the proportion of patients who received systemic therapy was significantly larger in the group of patients with a SAR(ICM) > 16 weeks than in the group of patients with a shorter survival.…”

Section: Discussionsupporting

confidence: 81%

“…Improved survival or a better performance status was achieved in patients with brain metastases if they were treated with either surgery [20,21], radiotherapy [22,23], chemotherapy [24] or combinations of these [25]. In this study a relatively greater proportion of the patients in the group with SAR(ICM)_ 16 weeks underwent surgical treat, ment of a single brain metastasis and radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of patients with short and long survivals after detection of intracranial metastases from breast cancer

Kamby¹,

Soerensen

1988

J Neuro-Oncol

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The clinical course of 106 patients with brain metastases from breast cancer was retrospectively studied. Median time of survival after detection of intracranial metastases (SAR(ICM] was 14 weeks (95% confidence limits: 10-19 weeks), and 25% of the patients survived for more than 37 weeks, while only 17% survived for one year. The occurrence of clinical, pathoanatomical and therapeutical variables in these patients were analyzed in a subgroup of 57 patients, who survived for less than 16 weeks, and compared with a subgroup of 49 patients, who survived for more than 16 weeks after detection brain metastases. None of the variables studied were associated with either of the two prognostic groups. Patients with short SAR(ICM) had, however, a greater number of extra-cranial metastases at recurrence in the brain compared to patients with SAR(ICM) more than 16 weeks (p = 0.07). Patients with SAR(ICM) less than 16 weeks had a somewhat shorter recurrence-free interval (p = 0.22) and a significantly shorter time from primary diagnosis until detection of brain metastases (p = 0.04). Probably as a consequence of this, these patients had a shorter survival from primary diagnosis as well as from first recurrence. The findings may indicate that the differences in survival of patients with brain metastases are mainly due to differences in the rate of disease progression.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Characteristics of patients with short and long survivals after detection of intracranial metastases from breast cancer

Kamby¹,

Soerensen

1988

J Neuro-Oncol

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“…Tumour cell resistance is probably a far more important reason for chemotherapy failure than is inability of the drug to cross the intact BBB, and any barrier might make relatively little difference for a highly cytotoxic drug (Wodinsky et al, 1977). Hence both we (reviewed in Stewart et al, 1983, 1986a-c, 1987a, 1989a, 1990a,b, 1994ac, Feun et al, 1985Stewart, 1987aStewart, ,b, 1989Stewart, , 1994 and several other investigators (reviewed in Kolaric et al, 1981;Rosner et al, 1983;Kantarajian et al, 1984;Stewart, 1989) (Shapiro, 1983). For lipid-insoluble drugs, cell membrane factors may be more important determinants of drug entry than is blood flow (Dedrick et al, 1975).…”

Section: D6cussionmentioning

confidence: 70%

Factors affecting platinum concentrations in human surgical tumour specimens after cisplatin

Molepo²,

Rm³

et al. 1995

Br J Cancer

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SinaryWe asessed factors which affect cisplatin concentrations in human surgical tumour specmen. al., 1994a;Stewart, 1994). For many chemotherapy drugs, only low concentrations are found in normal brain and cerebrospinal fluid (CSF), because of the BBB and blood-CSF barrier, but the barrier is often largely disrupted in patients with brain tumours (Blasberg and Groothuis, 1986). In animal models, the degree of BBB disruption varies from one type of tumour to another and between parts of the same tumour (Groothuis et al., 1981;Blasberg and Groothuis, 1986). Lower concentrations of chemotherapy drugs (Levin et al., 1972;Tator, 1976;Groothuis et al., 1981) and lower capillary permeability (Hasegawa et al., 1983) It has also been argued that resistance of IC tumours may be due in part to invasion of tumour cells into the brain adjacent to tumour (BAT), where the BBB is more intact, and where drug concentrations are lower than in the main body of the tumour (Levin et al., 1975). However, the importance in brain tumour chemotherapy of resistance of tumour cells in the BAT remains controversial. Since even small numbers of tumour cells may induce leakiness in local blood vessels (Stewart et al., 1987), small tumour deposits in the BAT could result in a very localised increase in drug concentrations, and it is uncertain how drug concentrations compare in individual tumour cells in BAT vs the main tumour body.We have studied several chemotherapy drugs with respect to the concentrations reached in human IC tumours (reviewed in Stewart et al., 1994a, Stewart, 1994. Concentrations in IC tumours appeared to be similar to those in EC tumours for cisplatin, phosphonacetyl-L-aspartate, 4'-(9-acridinylamino)-methanesulphon-m-aniside (AMSA), pentamethylmeamine, doxorubicin and vinblasine. Concentrations of etoposide and mitoxantrone in IC tumours were somewhat lower than in EC tumours. Since no EC tumour samples were available, comparisons were not possible for a variety of other agents, but for most of these drugs potentially cytotoxic concentrations were achieved in human IC tumours. Low drug concentrations in normal brain and CSF did not preclude high concentrations in IC tumours.In this paper, we report the results of further studies of human tumour accumulation of the chemotherapy drug cisplatin. These studies were done since our earliest studies of surgical specimens had looked only at IC tumours. While our later autopsy studies had looked at both IC and EC tumours, there were differences between patients with respect to drug doses, time from last treatment to death, concurrent drugs, etc. (reviewed in Stewart et al., 1994a; Stewart, 1994). Hence, we conducted the studies reported in this paper so that a companson could be made between IC and EC tumours

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“…Opinions also differ as to whether it is better to use a carcinostatic agent to which the primary lesion is sensitive, or a lipid-soluble nitrosourea carcinostatic agent that can cross the blood-brain barrier. However, this barrier is already partially disrupted in cases of metastatic brain tumors, and chemotherapeutic agents which are effective on the primary lesion have often been reported to be effective on the metastatic lesions as well [10,11]. For these reasons, most clinicians support the use of the former carcinostatic agents [12].…”

Section: Discussionmentioning

confidence: 99%

Cis-diamminedichloroplatinum (CDDP) therapy for brain metastasis of lung cancer

et al. 1993

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Parenchymal brain tumors, which were metastases of primary lung cancer, were surgically removed from 25 patients. During the operation, patients were administered (intravenous or intracarotid) 100 mg/sq m of cis-diamminedichloroplatinum (CDDP) and postoperatively, they received intravenous CDDP at 3-month intervals for 1 year. The results of this mode of treatment were compared with those obtained in 25 patients who underwent the same surgery but received other anticancer agents and in 39 patients who received no postoperative chemotherapy. Patients in the CDDP-treated group survived much longer than both of the other treatment groups. In the CDDP, but not in the other two groups, survival was significantly longer in patients who had undergone resection of their lung tumors than in those who had not. The stage of lung cancer was not found to significantly influence survival time among CDDP-treated patients. Brain metastasis was the cause of death in 12% of the patients who received CDDP, in 16% those treated with other drugs, and in 26% of those who received no chemotherapy. The incidence of local and remote intracranial tumor recurrence, including meningeal carcinomatosis, was similar in the three groups. However, the mean interval from resection of the metastatic brain tumor to local or remote recurrence was longer in the CDDP-treated group than in the other two groups, and the 2-year-survival rate was significantly higher after CDDP administration. These results suggest that CDDP may be useful in the therapy of metastatic brain tumors derived from lung cancer.

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Management of brain metastases from breast cancer by combination chemotherapy

Cited by 43 publications

References 23 publications

Characteristics of patients with short and long survivals after detection of intracranial metastases from breast cancer

Characteristics of patients with short and long survivals after detection of intracranial metastases from breast cancer

Factors affecting platinum concentrations in human surgical tumour specimens after cisplatin

Cis-diamminedichloroplatinum (CDDP) therapy for brain metastasis of lung cancer

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