Trastuzumab Emtansine (T-DM1) and stereotactic radiation in the management of HER2+ breast cancer brain metastases

BMC Cancer

Brian J. Czerniecki¹  Hyo S. Han¹  Hatem H. Soliman¹  Arnold Etame²  Michael A. Vogelbaum²  James Liu²  Peter A. Forsyth²  Matthew N. Mills³  Nicholas B. Figura³  Kamran A. Ahmed³  Hsiang-Hsuan Michael Yu³  Timothy J. Robinson³  Sergiy Kushchayev⁴  Chetna Thawani⁵  Chelsea Walker⁵  Afrin Naz⁵ 

[1] Departments of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 33612, Tampa, FL, USA;Departments of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, 33612, Tampa, FL, USA;Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., 33612, Tampa, FL, USA;Departments of Radiology, H. Lee Moffitt Cancer Center and Research Institute, 33612, Tampa, FL, USA;University of South Florida, Morsani College of Medicine, 33612, Tampa, FL, USA;

关键词: Trastuzumab emtansine;    Kadcyla;    Breast cancer;    Brain metastases;    Stereotactic radiotherapy;   

DOI  :  10.1186/s12885-021-07971-w

来源: Springer

【 摘 要 】

BackgroundDue to recent concerns about the toxicity of trastuzumab emtansine (T-DM1) with stereotactic radiation, we assessed our institutional outcomes treating HER2-positive breast cancer brain metastases (BCBM) with T-DM1 and stereotactic radiation.MethodsThis is a single institution series of 16 patients with HER2-positive breast cancer who underwent 18 stereotactic sessions to 40 BCBM from 2013 to 2019 with T-DM1 delivered within 6 months. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), distant intracranial control (DIC), and systemic progression-free survival (sPFS) from the date of SRS. A neuro-radiologist independently reviewed follow-up imaging.ResultsOne patient had invasive lobular carcinoma, and 15 patients had invasive ductal carcinoma. All cases were HER2-positive, while 10 were hormone receptor (HR) positive. Twenty-four lesions were treated with stereotactic radiosurgery (SRS) to a median dose of 21 Gy (14–24 Gy). Sixteen lesions were treated with fractionated stereotactic radiation (FSRT) with a median dose of 25 Gy (20-30Gy) delivered in 3 to 5 fractions. Stereotactic radiation was delivered concurrently with T-DM1 in 19 lesions (48%). Median follow up time was 13.2 months from stereotactic radiation. The 1-year LC, DIC, sPFS, and OS were 75, 50, 30, and 67%, respectively. There was 1 case of leptomeningeal progression and 1 case (3%) of symptomatic radionecrosis.ConclusionsWe demonstrate that stereotactic radiation and T-DM1 is well-tolerated and effective for patients with HER2-positive BCBM. An increased risk for symptomatic radiation necrosis was not noted in our series.

【 授权许可】

CC BY