HER2 Support Group Forums - View Single Post - you are not going to like this--first evidence based guidelines 4 brain met treatment

Rich66 · 11-09-2009, 11:37 AM

I too wonder about blanket terms like "chemotherapy". There are things like Tykerb, antibody approaches and small molecule approaches which may have efficacy. Are those "chemotherapy"?
Best conflicted quote:

"new targeted agents such as bevacizumab (Avastin), which has shown promise in the treatment of glioblastoma multiforme, might not be as useful in the treatment of brain metastases, "but the evidence is not yet definitive."
We are specifically recommending that chemotherapy not be used for brain metastases. "

Evidence isn't in..but the recommendation is. I get it.

But wait...3.5 seconds on pubmed shows:

Ann Oncol. 2009 Oct 19. [Epub ahead of print]
Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT).

CONCLUSIONS: HER2-positive and triple-negative breast cancers have special predilection for metastases to the brain. Survival from brain metastases depended on performance status and the use of systemic treatment.

More on variable efficacy

Herceptin prolongs survival

"extended survival"

PMID: 19840953 [PubMed - as supplied by publisher]

Womens Health (Lond Engl). 2009 Nov;5(6):603-12.
Lapatinib in metastatic breast cancer.

Frenel JS, Bourbouloux E, Berton-Rigaud D, Sadot-Lebouvier S, Zanetti A, Campone M.
Oncologie Médicale, Institut Regional du Cancer Nantes Atlantique CRLCC René Gauducheau, Bd Jacques Monod 44805 Nantes Cedex/Saint-Herblain, France. jsfrenel44@aol.com
Lapatinib is an oral, small-molecule, dual kinase inhibitor that targets both HER2 and the EGF receptor. Lapatinib was approved in June 2008 in Europe for the treatment of advanced HER2-positive breast cancer. Promising results in trastuzumab-refractory metastatic breast cancer were obtained from Phase I, II and III studies in combination with chemotherapy. Diarrhea and rash are the most common side-effects and are mostly moderate and treatable. Cardiac toxicity occurs rarely and mostly as an asymptomatic and reversible decrease of left ventricular ejection fraction. Unlike trastuzumab, some data show that lapatinib could cross the blood-brain barrier, with some evidence of activity in treating or preventing brain metastases. Its evaluation is actively ongoing, in combination with trastuzumab and in the adjuvant setting.

PMID: 19863462 [PubMed - in process]

Lapatinib with Capecitabine partial responses

Sagopilone in phase II, including BC

ANG1005 Taxol+Peptide crosses BBB

Another overlooked aspect of Tamoxifen?

Oh..and in an e-mail from a researcher/drug developer on BBB:
"Sometimes this barrier is compromised in brain metastases, sometimes not. "
Not sure if he was talking about BC but..

11-09-2009, 11:37 AM	#15
Rich66 Senior Member Join Date: Feb 2008 Location: South East Wisconsin Posts: 3,431	Re: you are not going to like this--first evidence based guidelines 4 brain met treat I too wonder about blanket terms like "chemotherapy". There are things like Tykerb, antibody approaches and small molecule approaches which may have efficacy. Are those "chemotherapy"? Best conflicted quote: "new targeted agents such as bevacizumab (Avastin), which has shown promise in the treatment of glioblastoma multiforme, might not be as useful in the treatment of brain metastases, "but the evidence is not yet definitive." We are specifically recommending that chemotherapy not be used for brain metastases. " Evidence isn't in..but the recommendation is. I get it. But wait...3.5 seconds on pubmed shows: Ann Oncol. 2009 Oct 19. [Epub ahead of print] Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT). CONCLUSIONS: HER2-positive and triple-negative breast cancers have special predilection for metastases to the brain. Survival from brain metastases depended on performance status and the use of systemic treatment. More on variable efficacy Herceptin prolongs survival "extended survival" PMID: 19840953 [PubMed - as supplied by publisher] Womens Health (Lond Engl). 2009 Nov;5(6):603-12. Lapatinib in metastatic breast cancer. Frenel JS, Bourbouloux E, Berton-Rigaud D, Sadot-Lebouvier S, Zanetti A, Campone M. Oncologie Médicale, Institut Regional du Cancer Nantes Atlantique CRLCC René Gauducheau, Bd Jacques Monod 44805 Nantes Cedex/Saint-Herblain, France. jsfrenel44@aol.com Lapatinib is an oral, small-molecule, dual kinase inhibitor that targets both HER2 and the EGF receptor. Lapatinib was approved in June 2008 in Europe for the treatment of advanced HER2-positive breast cancer. Promising results in trastuzumab-refractory metastatic breast cancer were obtained from Phase I, II and III studies in combination with chemotherapy. Diarrhea and rash are the most common side-effects and are mostly moderate and treatable. Cardiac toxicity occurs rarely and mostly as an asymptomatic and reversible decrease of left ventricular ejection fraction. Unlike trastuzumab, some data show that lapatinib could cross the blood-brain barrier, with some evidence of activity in treating or preventing brain metastases. Its evaluation is actively ongoing, in combination with trastuzumab and in the adjuvant setting. PMID: 19863462 [PubMed - in process] Lapatinib with Capecitabine partial responses Sagopilone in phase II, including BC ANG1005 Taxol+Peptide crosses BBB Another overlooked aspect of Tamoxifen? Oh..and in an e-mail from a researcher/drug developer on BBB: "Sometimes this barrier is compromised in brain metastases, sometimes not. " Not sure if he was talking about BC but.. __________________ Mom's treatment history (link)