Stereotactic Radiation and Dual Human Epidermal Growth Factor Receptor 2 Blockade with Trastuzumab and Pertuzumab in the Treatment of Breast Cancer Brain Metastases: A Single Institution Series

Abstract

(1) Background: This study aims to assess the safety and efficacy of fractionated SRT (fSRT) and pertuzumab–trastuzumab (PT) in patients with breast cancer brain metastases (BCBM). (2) Methods: Patients with HER2+ BCBM who received FSRT from 2015 to 2019 were identified. Patients were included if they were treated with fSRT within 21 days of receiving PT. All lesions were treated with LINAC-based fSRT to a total dose of 27 Gy delivered in three consecutive fractions. All patients received concurrent PT. Patients were evaluated 4–6 weeks after SRS and subsequently every 2–3 months with MRI re-imaging (3) Results: A total of 49 patients with HER2+ brain metastases were identified. Of these patients, a total of 10 patients with 32 HER2+ BCBM were treated with concurrent SRT and PT and included in the analysis. No local progression was observed. Overall response rate was 68.7%. Only one patient developed asymptomatic radionecrosis. Median time to BM occurrence was 15.6 (range: 1–40.5 months). Distant intracranial failure occurred in 4/10 patients (40.0%). Overall BCBM median survival was 33.9 months (95%CI 24.1–43.6). Mean duration of PT treatment was 27.9 months (range: 10.1–53.7 months). (4) Conclusions: In our single institution experience, fSRT and PT showed to be a safe treatment for patients with BCBM with an adequate overall response rate.

International multidisciplinary consensus on the integration of radiotherapy with new systemic treatments for breast cancer: European Society for Radiotherapy and Oncology (ESTRO)-endorsed recommendations

“…45,46 For patients undergoing whole-brain radiotherapy or stereotactic radiotherapy for brain metastases, the concurrent use of trastuzumab, pertuzumab, or both has been well tolerated, with no increased risk of adverse events. 47,48 The recently published EORTC-ESTRO OligoCare recommendations on the use of targeted drugs in combination with SABR present a consensus that trastuzumab and pertuzumab can be administered concomitantly with radiotherapy, without the need for dose reduction. 6 In the ALLTO and NeoALLTO trials, postoperative locoregional radiotherapy was administered con currently with lapatinib tosilate, trastuzumab, or both.…”

Neurologic complications of breast cancer

“…33,34 In a singleinstitution study of 49 patients who had HER2-positive BMs treated with concurrent trastuzumab and pertuzumab, only one patient experienced radionecrosis. 35 Retrospective studies evaluating concurrent trastuzumab emtansine (T-DM1) with SRS reported that radionecrosis occurred in 40%-50% of patients, thus its concomitant use during SRS has a potential risk of radionecrosis, although the studies mentioned were small and retrospective. 36,37 There is no current evidence available for the risk of radionecrosis with concurrent trastuzumab deruxtecan (T-DXd).…”

Impact of anticancer therapy on the quality of life of Sudanese patients with breast cancer at Khartoum oncology hospital

“…Tamoxifen (ER antagonist) is the standard drug for ER-positive patients, and it is used in both premenopausal and postmenopausal women whereas aromatase inhibitors (anastrozole, and letrozole) are used in postmenopausal women, especially with advanced BC [12]. HER2-directed therapy (e.g., Trastuzumab) is approved for the treatment of HER2-positive BC, and it may be safely combined with radiotherapy, chemotherapy, and endocrine therapy [11,13].…”