This study done by the Chinese has a good explanation of why Herceptin(Trastuzumab) seems to be linked to higher incidence of brain mets:
PLoS One. 2011;6(6):e21030. Epub 2011 Jun 9.
Trastuzumab in the Adjuvant Treatment of HER2-Positive Early Breast Cancer Patients: A Meta-Analysis of Published Randomized Controlled Trials.
Yin W,
Jiang Y,
Shen Z,
Shao Z,
Lu J.
Source
Department of
Breast Surgery, Fudan University Shanghai
Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Abstract
BACKGROUND:
Adjuvant trastuzumab therapy has yielded conflicting results for overall survival, concerns about
central nervous system (CNS) metastasis, and questions about optimal schedule. Therefore, we carried out a meta-analysis to assess the benefits of concurrent or sequential trastuzumab with adjuvant chemotherapy for early
breast cancer patients with
HER2-positive tumors.
METHODS:
Computerized and manual searches were performed to identify randomized clinical trials comparing adjuvant chemotherapy with or without trastuzumab in
HER2-positive early
breast cancer patients. Odds ratios were used to estimate the association between the addition of trastuzumab to adjuvant chemotherapy and various survival outcomes. The fixed-effects or random-effects model was used to combine data.
FINDINGS:
With six eligible studies identified, this analysis demonstrated that patients with
HER2-positive
breast cancer derived benefit in disease-free survival, overall survival, locoregional
recurrence and distant
recurrence (all P<0.001) from the addition of trastuzumab to adjuvant chemotherapy, whereas trastuzumab did worse in CNS
recurrence as compared to the control group (P = 0.018). Furthermore, concomitant use of trastuzumab significantly lowered the hazard of death (P<0.001) but bore a higher incidence of CNS
recurrence (P = 0.010), while statistical significance failed to be discerned for either overall survival (P = 0.069) or CNS metastasis (P = 0.374) between the sequential and observation arms.
CONCLUSION:
This analysis verifies the efficacy of trastuzumab in the adjuvant setting. Additionally, our findings indirectly corroborate the superiority of concurrent trastuzumab to sequential use and also illuminate that
prolonged survival is the possible reason for the higher incidence of CNS with trastuzumab versus observation.
__________________
Jackie07
http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2
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