Brain MRI and Muga

[eric]

Hi all,

2 questions...
My wife, Caryn, last had a brain MRI in January and because her tumor markers seems to be a good gauge of how she's doing her onc moved her scans to every 6 months. As a result she has a CT and PET scheduled shortly but when she asked about a brain MRI the doc said that he wouldn't do it since he feels that it's too early. It seems that the general consensus here is to do them every 3 months so I'm wondering if I should push the issue. He's been pretty good about doing what we've asked for to date but I'm not sure if this is the right decision. As a reminder, she was diagnosed with mets to lungs and liver in July of '04 and after Gemzar/Herceptin she was declared NED in January. Thankfully she's been only on weekly herceptin ever since.

My second question revolves around the Muga. She had one Muga before starting herceptin mid '04 and hasn't had one since. The onc says that it's only needed when combined with chemo.

I welcome your thoughts.

Warmest regards,
Eric

[*_sally_*]

My doctor says a mugga every year if your on Herceptin and I have never gotten a brain scan of any kind. I've have PET and CT scans but I don't think they do the brain. Do they?? Sally

[Barbara H.]

Hi Eric,
I have a MRI every 3 months, but I also was diagnosed with a brain met a year ago.
Best wishes,
Barbara H.

[mamacze]

Hi Eric!
I get scanned every 3 months and a MUGA every 6 months...My mets is to my lungs...
Kim from CT

[imported_Joe]

This was presented at ASCO this weekend,

Warmest Regards
Joe



Clinicopathological study of brain metastases in breast cancer patients treated with or without trastuzumab
Abstract No: 693
Author(s): Y. Saito, Y. Tokuda, Y. Suzuki, S. Umemura, R. Y. Osamura
Abstract: Background: Trastuzumab plays the important role in the treatment of patients with HER2 overexpressing metastatic breast cancer. Since its introduction into the treatment strategy of metastatic breast cancer, brain metastases during trastuzumab therapy have been frequently observed. Only a few studies have compared the risk of brain metastases in patients treated with or without trastuzumab. Methods: We conducted the retrospective and clinicopathological study of the fifty-seven patients with brain metastases treated in our hospital between 1989 and 2003. Those fourteen patients with brain metastases were surgically removed to be pathologically compared with primary tumors. Results: Twenty-seven patients were positive for HER2, while the remaining thirty patients were negative. The time from the first recurrence to brain metastases and the median overall survival time were not significantly different between HER2 positive and negative patients. Nineteen patients were treated with the trastuzumab-based therapy out of twenty seven HER2 positive patients. The time from the first recurrence to brain metastases was 17.4months for those patients who received trastuzumab-based therapy, while 8.3 months for the patients who did not receive trastuzumab (p<0.01). The survival period after brain metastases was 9.8months for the patients who received trastuzumab, while 1.1 months for the patients who did not receive trastuzumab (p<0.01). The median overall survival period was 51.8 month for those patients who received trastuzumab and 34.4 months for the patients who did not received trastuzumab(p<0.01). The fourteen tumors of the brain had the same HER2 status to primary tumors, except one tumor changed negative. Conclusions: This study showed that trastuzumab patients with brain metastases have survived significantly longer interval after first recurrence and the development of brain metastases, when comparing with control group.

[imported_Joe]

And More !!!



Brain metastases from breast cancer: Survival by HER2 status in the trastuzumab era.
Abstract No: 779
Citation: Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition). Vol 22, No 14S (July 15 Supplement), 2004: 779
Author(s): D. G. Kirsch, C. J. Ledezma, C. S. Mathews, M. Ancukiewicz, A. K. Bahn, F. H. Hochberg, J. S. Loeffler; Massachusetts General Hospital, Boston, MA
Abstract: Background: Brain metastases from breast cancer develop in 15% to 30% of women with metastatic breast cancer. Survival after brain metastases from breast cancer was assessed in the era of trastuzumab. Methods: Women with brain metastases from breast cancer that were treated or evaluated at the Massachusetts General Hospital since 1998 were retrospectively identified through hospital records or databases in the Department of Radiation Oncology and Neuro-Oncology. 109 women were identified as having breast cancer that metastasized to the brain. Tumors were classified as HER2 overexpressed if HER2 immunohistochemistry (IHC) was reported as 3+ or if Her2 gene amplification was present by fluorescent in situ hybridization (FISH). Tumors were classified as HER2 non-overexpressed if HER2 IHC was 1+ or if the Her2 gene was not amplified by FISH. Age at primary breast cancer diagnosis, time to develop brain metastasis, and survival after developing brain metastasis were compared for patients stratified by HER2 status. Results: In 91 of the 109 patients, HER2 status could be evaluated. 46 patients had tumors that did not overexpress HER2, while 45 patients had tumors that did overexpress HER2. 35 of these patients were treated with trastuzumab. There was no statistically significant difference between the age of primary breast cancer diagnosis (mean 48.1 years) or time to develop brain metastases (mean 58.2 months) according to HER2 status. However, patients with HER2 overexpressing breast cancer had a significantly longer overall survival (median 23 months vs. 10 months) after the development of brain metastases (p=0.0016 by log rank test). Conclusions: In the trastuzumab era, women with brain metastases with HER2 overexpressing breast cancer have a significantly improved survival. Better systemic disease control with HER2-targeted therapy may account for the improved survival for patients with HER2 overexpressing brain metastases. Further gains would likely result from HER2-targeted therapy that can cross the blood-brain barrier.

[StephN]

Hi Eric -

First, I wish to thank Joe for posting the good news. And there are many of us who are still adding to the stats and pushing the survival rates even further out. (Me included!)

Good news that Caryn is NED! If your wife has not had a brain met yet, she is lucky to get a brain MRI more often than once a year. That seems to be the normal time frame for screening, unless she has a specific complaint that would warrent it.
Those of us with brain mets are the ones who get the every-three-month brain MRI schedule.

I have not had a MUGA since starting on my clinical trial to beat out my liver mets. That is 3.5 years ago. I did have some heart workups lately as I had tightness in my chest, but that seems to be due to other causes. My onc says as long as my blood pressure is stable and other frequent monitoring shows nothing, there is no need as I have been off chemo for so long now. Once we have shown the our bodies acept the Herceptin, he sees no need to do MUGAs unless some change or complaint would show a need.

I only get my abdominal CT scans every 6-months now, as markers are stable.

[eric]

Thanks to all, your info helped.

Eric