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

Authors

Matthew N Mills
Chelsea Walker
Chetna Thawani
Afrin Naz
Nicholas B Figura
Sergiy Kushchayev
Arnold Etame
Hsiang-Hsuan Michael Yu
Timothy J Robinson
James Liu
Michael A Vogelbaum
Peter A Forsyth
Brian J Czerniecki
Hatem H Soliman
Hyo S Han
Kamran A Ahmed

Publication/Presentation Date

3-4-2021

Abstract

BACKGROUND: Due 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.

METHODS: This 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.

RESULTS: One 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.

CONCLUSIONS: We 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.

Volume

21

Issue

1

First Page

223

Last Page

223

ISSN

1471-2407

Published In/Presented At

Mills, M. N., Walker, C., Thawani, C., Naz, A., Figura, N. B., Kushchayev, S., Etame, A., Yu, H. M., Robinson, T. J., Liu, J., Vogelbaum, M. A., Forsyth, P. A., Czerniecki, B. J., Soliman, H. H., Han, H. S., & Ahmed, K. A. (2021). Trastuzumab Emtansine (T-DM1) and stereotactic radiation in the management of HER2+ breast cancer brain metastases. BMC cancer, 21(1), 223. https://doi.org/10.1186/s12885-021-07971-w

Disciplines

Medical Education | Medicine and Health Sciences

PubMedID

33663447

Department(s)

USF-LVHN SELECT Program, USF-LVHN SELECT Program Students

Document Type

Article