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agness · 09-11-2015, 12:23 PM

ASCO Guideline for Management of Brain Metastases From HER2-Positive Breast Cancer: An Important Framework

http://www.ascopost.com/issues/july-...framework.aspx
[2014]

"In the Breast Cancer Graded Prognostic Assessment, a prognostic scoring metric derived from a multi-institutional database of 400 breast cancer patients, the median overall survival was 17 months (95% confidence interval [CI] = 13–23) in HER2-positive patients with brain metastases3; significant prognostic factors were Karnofsky performance status, age, HER2 status, and the interaction between estrogen receptor and progesterone receptor status and HER2. Other large retrospective series have reported median survival as high as 23 months in these patients."

"These recommendations also highlight the areas of need for randomized trials of systemic agents in both newly diagnosed and recurrent brain metastases. Indeed, interpreting results from clinical trials and their applicability to patients has been a challenge, given the heterogeneous patient populations and variable endpoints across trials. Traditional cytotoxic agents have some activity in the brain,5 but have often required coordination with radiation and/or surgical interventions to obtain durable control. As systemic therapies improve and begin to include combinations of agents with penetration across the blood-brain barrier, the guidelines will also likely evolve to include more frequent use of chemotherapeutic regimens as a primary treatment modality for HER2-positive breast cancer brain metastases."

09-11-2015, 12:23 PM	#12
agness Senior Member Join Date: Aug 2014 Location: Seattle, WA Posts: 285	Re: Compiling Data on HER2 Brain Mets ASCO Guideline for Management of Brain Metastases From HER2-Positive Breast Cancer: An Important Framework http://www.ascopost.com/issues/july-...framework.aspx [2014] "In the Breast Cancer Graded Prognostic Assessment, a prognostic scoring metric derived from a multi-institutional database of 400 breast cancer patients, the median overall survival was 17 months (95% confidence interval [CI] = 13–23) in HER2-positive patients with brain metastases3; significant prognostic factors were Karnofsky performance status, age, HER2 status, and the interaction between estrogen receptor and progesterone receptor status and HER2. Other large retrospective series have reported median survival as high as 23 months in these patients." "These recommendations also highlight the areas of need for randomized trials of systemic agents in both newly diagnosed and recurrent brain metastases. Indeed, interpreting results from clinical trials and their applicability to patients has been a challenge, given the heterogeneous patient populations and variable endpoints across trials. Traditional cytotoxic agents have some activity in the brain,5 but have often required coordination with radiation and/or surgical interventions to obtain durable control. As systemic therapies improve and begin to include combinations of agents with penetration across the blood-brain barrier, the guidelines will also likely evolve to include more frequent use of chemotherapeutic regimens as a primary treatment modality for HER2-positive breast cancer brain metastases." __________________ Dx 2/14 3b HER2+/HR- left breast, left axilla, internal mammary node (behind breast bone). Neoadjuvant TCHP 3/14-7/2. PCR 8/14 LX and SND. 10/21-12/9 Proton therapy to chest wall. Dx 7/20/15 cerebellar met 3.5x5cm HER2+/HR-/GATA3+ 7/23/15 Craniotomy. 7/29/15 bone scan clear. 8/3/15 PET clean scan. LINAC SRS (5 fractions) Sept 2015. 9/17/15 CSF NED, 9/24/15 CSF NED, 11/2/15 CSF NED. 10/27/15 atypical uptake in right cerebellum - inflammation? 12/1/15 Leptomeningeal dx. Starting IT Herceptin. 1/16 - 16 fractions of tomotherapy to cerebellum, break of IT Herceptin during rads, resume at 100 mg weekly 3/2016 - stable scan 5/2016 stable scan 7/2016 pseudoprogression? 9/2016 more LM, start new chemo protocol and IV therapy treatment with HBOT 11/2016 Cyberknife to temporal lobe, HBOT just prior 12/2016 - lesions starting to show shrinkage 8/2017 - Stable since Dec 2016. Temporal lobe lesion gone. Using TCM, naturopathic oncology, physical therapy, chiro, massage, medical qigong, and energetic healing modalities in tandem. Stops at nothing. Mother of 2 boys - ages 7 and 10 (8/2017) and a lovely partner with lots to live for.