Concurrent Capecitabine and WBRT (whole brain radiation therapy) MAY be synergistic

[Lani]

call for prospective randomized clinical trial in this article: Upon reviewing the paper more closely, all five patients' original tumors were her2- and brain mets were not biopsied to determine her2 status. I thought this might be helpful in that it MAY imply that when combined with WBRT capecitabine MAY be present in sufficent amounts despite the BBB to be effective. As Lapatinib is only FDA approved when used with capecitabine (xeloda) and when used for brain mets I wondered if they might try to change to concurrent treatment with radiation therapy (WBRT vs cyber/gamma knife) with capecitabine/lapatinib. Just thinking out loud.


J Neurooncol. 2009 Jan 25. [Epub ahead of print]

Concurrent capecitabine and whole-brain radiotherapy for treatment of brain metastases in breast cancer patients.

Chargari C, Kirova YM, Diéras V, Pena PC, Campana F, Cottu PH, Pierga J, Fourquet A; Institut Curie Breast Cancer Study Group.
Department of Radiation Oncology, Department of Medical Oncology, Institut Curie, 26, Rue d'Ulm, 75005, Paris, France.
Preclinical data have demonstrated that ionizing radiation acts synergistically with capecitabine. This report retrospectively assessed the use of capecitabine concurrently with whole-brain radiotherapy (WBRT) in patients with brain metastases from breast cancer. From January 2003 to March 2005, five breast cancer patients with brain metastases were referred for WBRT with concurrent capecitabine. Median age was 44 years (range: 38-53). The median dose of capecitabine was 1,000 mg/m(2) twice daily for 14 days (day1-14). Treatment cycles were repeated every 21 days, concurrently with WBRT (30 Gy, 3 Gy per fraction, 5 days per week). Median survival after starting WBRT plus capecitabine was 6.5 months (range 1-34 months). One patient achieved a complete response. Two patients achieved partial response, including one with local control lasting until most recent follow-up. One patient had stable disease. The remaining patient was not assessable for response because of early death. Most commonly reported adverse events were nausea (n = 2) and headache (n = 2), always grade 1. Other toxicities were grade 3 hand/foot syndrome (n = 1), moderate anemia requiring transfusion and dose reduction of capecitabine (n = 1), and grade 1 mucositis (n = 1). Although promising, these preliminary data warrant further assessment of capecitabine-based chemoradiation in brain metastases from breast cancer and need to be further validated in the setting of a clinical trial.
PMID: 19169856