HER2 Support Group Forums - View Single Post - Intrathecal (IT) Herceptin (Trastuzumab) for brain mets (Leptomeningeal Metastases)

schoonder · 05-15-2014, 01:18 PM

ASCO abstract re: T-DM1
"Author(s): Rupert Bartsch, Anna Sophie Berghoff, Margareta Rudas, Elisabeth Bergen, Michael Gnant, Karin Dieckmann, Katja Pinker, Christoph Zielinski, Guenther G. Steger, Matthias Preusser; Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute of Neurology, Medical University of Vienna, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department for Radiation Therapy and Radiation Biology, Medical University of Vienna, Vienna, Austria; Department of Radiology, Medical University of Vienna, Vienna, Austria; Medical University of Vienna, and Initiative “Leben mit Krebs, Vienna, Austria, Vienna, Austria; Department of Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
Abstract Disclosures

Abstract:

Background: Local treatment options such as radiotherapy or neurosurgery are the mainstay of BM management. Whole brain radiotherapy (WBRT), however, is associated with severe late-toxicity. The LANDSCAPE trial established lapatinib plus capecitabine (LapCap) as primary systemic treatment in oligosymptomatic patients (pts) with multiple Her2-positive BM. Limited evidence exists regarding the activity of antibodies in BM. T-DM1 is an antibody-drug conjugate linking trastuzumab (T) to an anti-microtubule agent. T-DM1 provides activity in pts progressing upon T and has lower toxicity as compared to LapCap. Here, we investigated the activity of T-DM1 in newly diagnosed or progressive BM. Methods: A total of six consecutive pts (median age 55 years) with Her2-positive breast cancer and BM were treated with T-DM1. In two asymptomatic pts, T-DM1 was administered as primary systemic therapy, while four subjects had already received local therapy and had documented CNS progression. T-DM1 was administered intravenously at a dose of 3.6 mg/kg body weight every three weeks; re-assessment of disease status was performed every three cycles. At baseline and restaging, MRI was performed. CNS response was defined as a reduction of lesion size of ≥50%. Results: Median follow-up was 6 months (m) and median brain metastases-free survival 11 m, respectively. All pts had received prior T, three (50%) had already received LapCap, and two (33.3%) pertuzumab. Currently, 4/6 pts (1 with primary treatment and 3 receiving T-DM1 upon CNS progression) are assessable for CNS response. 2/4 pts (50%) had partial remission, while one patient progressing upon prior local therapy had stable disease lasting for 15 cycles. One patient had minor response on MRI but no reduction of pre-existing brain oedema and increasing cortisol doses and was therefore deemed PD. A significant LVEF drop was observed in one heavily pretreated patient. Conclusions: This prospective case series again indicates that systemic therapy offers activity in Her2-positive BM. Currently, LapCap remains the standard of care. Still, T-DM1 offers relevant clinical activity; therefore, the role of T-DM1 in BM should be investigated in larger studies."
http://abstracts.asco.org/144/AbstView_144_134326.html

You're a real trooper Rolepaul.

05-15-2014, 01:18 PM	#168
schoonder Senior Member Join Date: Jul 2008 Posts: 186	Re: Intrathecal (IT) Herceptin (Trastuzumab) for brain mets (Leptomeningeal Metastase ASCO abstract re: T-DM1 "Author(s): Rupert Bartsch, Anna Sophie Berghoff, Margareta Rudas, Elisabeth Bergen, Michael Gnant, Karin Dieckmann, Katja Pinker, Christoph Zielinski, Guenther G. Steger, Matthias Preusser; Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute of Neurology, Medical University of Vienna, Vienna, Austria; Institute of Pathology, Medical University of Vienna, Vienna, Austria; Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department for Radiation Therapy and Radiation Biology, Medical University of Vienna, Vienna, Austria; Department of Radiology, Medical University of Vienna, Vienna, Austria; Medical University of Vienna, and Initiative “Leben mit Krebs, Vienna, Austria, Vienna, Austria; Department of Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria Abstract Disclosures Abstract: Background: Local treatment options such as radiotherapy or neurosurgery are the mainstay of BM management. Whole brain radiotherapy (WBRT), however, is associated with severe late-toxicity. The LANDSCAPE trial established lapatinib plus capecitabine (LapCap) as primary systemic treatment in oligosymptomatic patients (pts) with multiple Her2-positive BM. Limited evidence exists regarding the activity of antibodies in BM. T-DM1 is an antibody-drug conjugate linking trastuzumab (T) to an anti-microtubule agent. T-DM1 provides activity in pts progressing upon T and has lower toxicity as compared to LapCap. Here, we investigated the activity of T-DM1 in newly diagnosed or progressive BM. Methods: A total of six consecutive pts (median age 55 years) with Her2-positive breast cancer and BM were treated with T-DM1. In two asymptomatic pts, T-DM1 was administered as primary systemic therapy, while four subjects had already received local therapy and had documented CNS progression. T-DM1 was administered intravenously at a dose of 3.6 mg/kg body weight every three weeks; re-assessment of disease status was performed every three cycles. At baseline and restaging, MRI was performed. CNS response was defined as a reduction of lesion size of ≥50%. Results: Median follow-up was 6 months (m) and median brain metastases-free survival 11 m, respectively. All pts had received prior T, three (50%) had already received LapCap, and two (33.3%) pertuzumab. Currently, 4/6 pts (1 with primary treatment and 3 receiving T-DM1 upon CNS progression) are assessable for CNS response. 2/4 pts (50%) had partial remission, while one patient progressing upon prior local therapy had stable disease lasting for 15 cycles. One patient had minor response on MRI but no reduction of pre-existing brain oedema and increasing cortisol doses and was therefore deemed PD. A significant LVEF drop was observed in one heavily pretreated patient. Conclusions: This prospective case series again indicates that systemic therapy offers activity in Her2-positive BM. Currently, LapCap remains the standard of care. Still, T-DM1 offers relevant clinical activity; therefore, the role of T-DM1 in BM should be investigated in larger studies." http://abstracts.asco.org/144/AbstView_144_134326.html You're a real trooper Rolepaul.