Treatment of breast cancer brain metastases: radiotherapy and emerging preclinical approaches

Abstract

The breast is one of the common primary sites of brain metastases (BM). Radiotherapy for BM from breast cancer may include whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and stereotactic radiotherapy (SRT), but a consensus is difficult to reach because of the wide and varied protocols, indications, and outcomes of these interventions. Overall, dissemination of disease, patient functional status, and tumor size are all important factors in the decision of treatment with WBRT or SRS. Thus far, previous studies indicate that WBRT can improve tumor control compared to SRS, but increase side effects, however no randomized trials have compared the efficacy of these therapies in BM from breast cancer. Therapies targeting long non-coding RNAs and transcription factors, such as MALAT1, HOTAIR, lnc-BM, TGL1, and ATF3, have the potential to both prevent metastatic spread and treat BM with improved radiosensitivity. Given the propensity for HER2+ breast cancer to develop BM, the above-mentioned cell lines may represent an important target for future investigations, and the development of everolimus and pyrotinib are equally important.

Pyrotinib for HER2-positive metastatic breast cancer: a systematic review and meta-analysis

“…In studies that have demonstrated improved efficacy in patients with brain metastases, the majority include whole-brain radiotherapy (when multiple brain metastases are present) or local radiotherapy [stereotactic radiosurgery (SRS) when one or two brain metastases are present] in their treatment regimens to disrupt the blood-brain barrier, allowing Pyrotinib to reach the brain metastases. These treatments provide favorable clinical practice evidence for radiation therapy for brain metastases from breast cancer (32). After transtuzumab/T-DM1 or lapatinib therapy, it continues to work effectively, implying that Pyrotinib has the potential to reverse HER2 resistance.…”

LINC00511 promotes cervical cancer progression by regulating the miR-497-5p/MAPK1 axis

“…Currently, surgery, chemotherapy, radiotherapy, targeted therapy and immunotherapy are the main treatment strategies for cancers [20][21][22]. However, these methods still couldn't cure most of the human malignancies, especially the metastatic diseases.…”

Advances in the Management of Central Nervous System Metastases from Breast Cancer

“…Local treatment for BM includes surgery, WBRT, SRS, fractionated stereotactic radiotherapy (fSRT), or a combination of these [ 6 , 22 ]. The decision of choosing one over another may be based on the estimated prognosis and the goals of the treatment [ 23 ].…”