Incidence of Brain Metastases in Patients on/having received Herceptin

[Lani]

1: Acta Oncol. 2006;45(2):196-201. Links

Incidence, pattern and timing of brain metastases among patients with advanced breast cancer treated with trastuzumab.

Yau T, Swanton C, Chua S, Sue A, Walsh G, Rostom A, Johnston SR, O'brien ME, Smith IE.

Breast Unit, Royal Marsden Hospital, Surrey SM2 5PT, UK.

We aim to investigate the incidence, patterns and timing of brain metastases in advanced breast cancer patients who have previously received trastuzumab. Eighty-seven patients who had received trastuzumab for advanced breast cancer from November 1999 to September 2003 at the Royal Marsden Hospital were assessed. With a median follow-up period of 11 months from commencing trastuzumab, 23 patients developed brain metastases (30% at 1 year; 95% CI 58-82%). Among 57 patients who had clinical benefits on trastuzumab, 12 (21%) patients developed first disease progression in brain with 75% of them had isolated CNS progression. Moreover, among patients who received trastuzumab as first line treatment, isolated brain metastases were the initial site of progression in 17% patients. Nearly all patients developed parenchymal brain disease. This study shows brain metastases are common phenomenon in HER2 positive advanced breast cancer patients receiving trastuzumab and also may implicate the brain as a sanctuary site for early relapse in this patient cohort.

PMID: 16546866 [PubMed - in process]

[aquinis2000]

The Truth Is Always Hard To Swallow, But Much Easier When We Can Prepare Ourselfs Fot It. Thanks For The Info. A2

[Joe]

I remember this study. Herceptin is not the cause of the tumors, but since it does not cross the blood brain barrier, is realitively inneffective in preventing brain tumors.

The HER2 Support Group is preparing a position paper on this subject which will be distributed at ASCO in June. It will summarize all of the data presented on this subject and will advocate for increased survielience of bc patients who are HER2 Positive by their oncologists.

Of course, we will also post this paper on our website.

Warmest Regards
Joe

[Sherryg683]

Doesn't lapitinab (sp?) do the same thing as Herceptin and also cross the BBB. When will this be approved...sherryg683

[Sherryg683]

"Nearly all patients developed parenchymal brain disease."
Exactly what is this?
sherryg683

I searched under parenchymal brain disease and here are four links that came up.

I am only a little the wiser and now have a whole host of questions. It does not make cheerful reading.

Points intrigued me - Re EGFR agonist. Isnt EGFR Erb 1 HER 1.
- Suggestion of links with heart disease
- Infamation
- Leaky cells

I looks from my very amateur reading that HER amongst other things is implicated in controlling body fat metabloism and creation (FAS). Is the blocking role of herceptin having an implication on fat pathways.

Inflamation and leaky cells also get a mention which are also factors evident in inflamatory diseases and potentially link back to fat metabolic pathways.

The brain is very heavily fat dependent.

Only random thoughts at this stage.

RAB





http://www.emedicine.com/RADIO/topic101.htm

http://spinwarp.ucsd.edu/NeuroWeb/Text/br-200.htm

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

http://www.nature.com/ncponc/journal...cponc0358.html

[Lani]

I am reading the complete article and think you may have misinterpreted the reference to "parenchymal" brain disease"--I think they are contrasting that to "leptomeningeal disease" ie, the problem is within the substance of the brain itself, rather than the lining of the brain.

I am unable to copy and paste from the article, as I have it as a pdf and have technical problems sending it as an email...oh well!

[Joe]

Here is the entire abstract.


Thanks Lani

I will go and try and find the article if on the web.

I had no idea what "parenchymal" brain disease" was I simply typed it into a search engine and looked at what came up.

It does raise interesting issues none the less. There is no question FAS and HER2 are linked. There is no question that the brain needs and uses long chain HUFAS.

It is not beyond the bounds of possibility that intervention in FAS could impact in long chain / lipid balance, which could in an already stressed scenario tip the balance in the brain towards expression of cancer. (And my wild ideas could be totally misplaced)

Thanks for a thought provoking post.

RB

[Lani]

I sent the article by attachment to Joe so he could paste it (just above your last post) as I couldn't seem to manage it.

I thought the whole article really helped explain it better.

Lani

You must have done it as I was posting, as it was not there when I started!

A very interesting article.

Thanks.

RB

here is another article stating same results


www.jco.org/cgi/content/full/20/19/4130-a - Similar pages

the date of the article last posted is 2002. seems as if this is not really new
news.

[julierene]

"Nearly all patients developed parenchymal brain disease."I couldn't get to the article either, what does it mean?

My onc scared me the other day when I asked him how long he thought I might have a break from chemo and he guessed maybe 1-2 years. I then asked about the brain - and he said it could happen at next recurrance or not. I asked him if there was anything we could do to help - he said pray.... My heart just sunk. Sorry to say this, but I don't believe God can heal my cancer - only my heart. It's a LONG story... But none the less, it REALLY scared me.

[Sherryg683]

This same thing has me wondering when "lapatinib" will be approved. Doesn't it do the same thing as Herceptin but also protect the brain. I will be on Herceptin indefinately and if Lapatinib will do the same thing plus cross the brain barrier, I think it's something that would be worth switching too. sherryg683

Julierene

The link has been posted by Joe above.

RB.