Some Refreshing News

[Joe]

Thanks to one of our healthcare professionals who sent me this link:

http://www.cancerpage.com/news/article.asp?id=9267


Regards
Joe

[al from Canada]

How could this news not be refreshing when it comes from such a refreshing person?

Thanks for this info Joe as it does offer much hope to some of our members. One thing that isn't mentioned in this article, is the effect herceptin has on survival, specifically with WBR, so I'm not sure if this applies to your article.


HER2-Positive Breast Cancer Brain Metastases Appear to Respond to Treatment with Herceptin (Trastuzumab): Presented at SABCS

By Ed Susman

SAN ANTONIO, TX -- December 14, 2001 -- Preliminary studies suggest that treatment of brain metastases with Herceptin (trastuzumab) can increase survival in patients with HER2-positive breast cancer.

Though the number of patients investigated was small, the researchers say their data indicates a survival benefit with a combination of taxanes and Herceptin in patients with brain metastases that develop from breast cancer overexpressing the human epidermal growth factor receptor 2 (HER2).

Maren Loebbecke, a researcher at Benjamin Franklin Medical Center, in Berlin, Germany, presented the results of this study at the 24th Annual San Antonio Breast Cancer Symposium, in San Antonio, Texas.

"Herceptin comprises a powerful treatment option in the therapy of HER2-overexpressing metastatic breast cancer," Loebbecke said. "Significant response rates and survival benefits have been established. Its effectiveness in patients with brain metastases, however, is still questionable, since a considerable number of patients develop brain metastases during Herceptin treatment."

Loebbecke, a fourth-year medical student at the medical center, presented data on 18 women with HER2-overexpressing breast cancer brain lesions who received taxane and/or trastuzumab treatment, and compared the results with patients receiving standard treatment for breast cancer.

"We saw a median survival of 25 months for the five patients who were treated with surgery, radiation, taxanes and Herceptin," Loebbecke said, "which compared with 10-month survival for six patients who received the same basic treatment but did not receive Herceptin."

Another group of nine patients with brain metastases who were treated with Herceptin and radiation had an average survival of 14 months. Four other patients who were treated only with Herceptin had a median survival of four months.

Loebbecke said that results are intriguing, "but right now we really can't say if Herceptin makes a difference. This was a retrospective analysis as well." However, she and her colleagues noted that the survival of 25 months was greater than that reported in the literature for patients who were treated similarly.

"Further studies regarding the central nervous system penetration of Herceptin and its effectiveness on brain metastases are required," Loebbecke said.

Her study, titled "Efficacy of Herceptin™ treatment on brain metastasis in women with HER2 overexpressing breast cancer", received funding support from Roche Pharmaceuticals

and from SABCS:

[4049] Improved survival after radiotherapy for brain metastases in patients with HER2 positive breast tumors.

Maur M, Frassoldati A, Piacentini F, Ramundo D, Sabbatini R, Giovannelli S, Ficarra G, Bertolini F, Falchi AM, Conte PF. University of Modena and Reggio Emilia, Modena, Italy

Background: A high incidence of brain metastases (BM) has been reported in patients with HER2 positive breast tumors. This could be the combined result of more aggressive tumor biology and better control of systemic disease with trastuzumab. In order to define how HER2 status affect the CNS involvement and the response to radiotherapy we conducted a retrospective chart review of patients (pts) with BM.
Patients and methods: Data from 53 consecutive patients with BM from BC were retrieved. Median age at CNS progression was 56 years (range 33 to 76); 38/53 pts (71%) had two or more CNS metastases (23 brain, 6 cerebellum, 14 brain/cerebellum, 3 brain/cerebellum/leptomeningeal), 43/53 pts (81%) had multiple extra cranial metastases. Median time to developing CNS mts after primary diagnosis was 50 months (range 32 to 236). Forty-one pts (77%) had received prior chemotherapy (37/53 antracycline-based, 21/53 taxane-based). The tumor biological characteristics were as follows: high grade 27/53 (51%), high proliferative rate (MIB-1 > 20%) 33/53 (62%), ER positive 23/53 (43%), PgR positive 12/53 (22%). Twenty-five (47%) were HER2 positive. Three patients only underwent to brain metastasectomy. Forty-nine pts were treated with whole brain radiotherapy (WBR) plus prednisolone (28 pts 30 Gy/10 fractions, 21 pts 20 Gy/5 fractions) and 4 pts had received stereotassic radiosurgery (SRS). At the time of diagnosis of BM 16/53 (30%) were on treatment with trastuzumab.
Results: No significant correlation between site of CNS relapse and tumor histology (p=0.877), grading (p=0.495), HER2 status (p=0.127), ER status (p=0.499), PgR status (p=0.152), anthracycline based (p=0.998) or taxane-based chemotherapy (p=0.756) was observed. The response status after radiotherapy was: 1 complete response (CR), 20 (57%) partial response (PR), 11 (31%) stable disease (SD), 3 (8.5%) progression disease (PD), response was not assessed in 18 pts. No difference between type of response to radiotherapy and histology (p=0.681), grading (p=0.183), HER2 status (p=0.844), CNS metastatic site (p=0.116), number of CNS mts (p=0.677) and trastuzumab-therapy (p=0.389) was observed. A significant better response was observed with high dose (30 Gy/10 fractions) of WBR (p= 0.01). So far 38/53 (72%) died for disease progression, 13/53 (25%) are alive with disease. Median survival of all pts was 9 mos. Significant predictors for better overall survival were: HER2 status (positive 21 mos vs negative 3 mos, p= 0.005), age (< 55 years 10 mos vs > 55 years 3 mos, p= 0.007) and among HER2 positive patients continuous treatment with trastuzumab (yes 21 mos vs no 5 mos, p=0.026).
Conclusions: breast cancer patients with HER2 positive BM experience a more long survival when treated with radiotherapy and trastuzumab.

Saturday, December 10, 2005 7:00 AM

Poster Session IV: Treatment: Radiation Therapy (7:00 AM-9:00 AM)

If a person is HER2+++ and responds to Herceptin, they have a good chance of doing better with overall survival than otherwise. Responding to Herceptin can control spread to organs etc, leaving a person with good Karnofsky score. Herceptin alone has nothing to do with brain mets according to current medical reports. That is my understanding.

The bottom line in "long term" survival with brain mets seems to be controlled mets otherwise. I've lost too many dear friends whose mets progressed in other areas, who did have controlled or near controlled brain mets.

[Gina]

Al's point...with any mets and especially BRAIN mets, the name of the game is reducing OVERALL tumor burden...if the person is significantly her-2 positive, Herceptin's role in facilitating the reduction of overall tumor burden can not be underestimated. What I think is bad is when oncs suspend Herceptin therapy in order to do "MORE ELABORATE" brain treatments which often can result as Patty's post so well illustrates in reduction or even removal of the brain mets at the expense of the person's general health and often results in loss of life from other causes far removed from the initial "brain mets" issue.

If for reasons beyond your control, your herceptin must be suspended or interupted during brain met treatment, be sure to at the very least watch your tumor markers...we have a case on this very board where both the CA 27/29 and serum her-2 increased significantly when the Herceptin was interrupted to aggressively go after Brain mets...Fortunately, however, lost ground can be recovered when the Herceptin is restarted..especially if it is restarted at the higher re-loading dose, but most oncs don't have a clue about stuff like this. It is YOUR BRAIN and YOUR BODY..smile...they are NOT separate, despite what Descartes would have us THINK that therefore we are...smile.

Gina